In late January a once-dominant figure in Republican politics suddenly began hinting at a presidential run and got a lot of negative feedback. It had to make Mitt Romney feel better.

Yes, 2008 GOP vice presidential nominee Sarah Palin pointedly refused to take herself out of the running for 2016. There were few cheers. And in a first, when Palin subsequently gave a scatterbrained and embarrassingly juvenile speech at Representative Steve King’s Iowa Freedom Summit, conservatives were as scornful as liberals.

In part that’s because the ratio between her brief career of statewide public office in Alaska and her subsequent self-promoting isn’t improving. But in part it’s also because she’s proved to be eminently replaceable in Republican politics.

St. Joan of the Tundra’s distinctive contribution to the conservative cause was not simply to serve as a lightning rod for resentment of the “liberal elites” that supposedly run the country, but to invite ridicule that she then turned into a sense of victimization and self-pity and a hankering for vengeance. For a while there, she could do no wrong, since every misstep turned into an opportunity for a fresh grievance against the mockery of snooty elitists.

Palin will hang around the periphery of conservative politics for some time (she’s a relatively young fifty). Her essential role of stimulating resentment and then promising vengeance, however, has been taken over by more conventional and respectable pols, much as George Wallace’s raw demagogic appeal in the 1960s was co-opted and refined by Richard Nixon. Indeed, one of the more notable developments of contemporary politics is the widespread preemption of Palin-style posturing against elites by other Republicans. These include potential 2016 presidential candidates ranging from Louisiana Governor Bobby Jindal, who has been seeking to brand himself as the champion of conservative Christians besieged by secularists and Muslims, to Mike Huckabee, whose new book, God, Guns, Grits, and Gravy, is a seething cauldron of resentment toward those who do not inhabit what Palin once memorably called “the real America.” But to a dangerous extent the whole party has absorbed some of the poison.

The mainstreaming of Palin’s act really began almost as soon as she burst onto the national scene in September of 2008, when Paul Krugman noted that the chip on the shoulder she exhibited was being emulated by other speakers at the Republican National Convention.

What struck me as I watched the convention speeches, however, is how much of the anger on the right is based not on the claim that Democrats have done bad things, but on the perception—generally based on no evidence whatsoever—that Democrats look down their noses at regular people.

Thus Mr. Giuliani asserted that Wasilla, Alaska, isn’t “flashy enough” for Mr. Obama, who never said any such thing. And Ms. Palin asserted that Democrats “look down” on small-town mayors—again, without any evidence.

What the GOP is selling, in other words, is the pure politics of resentment; you’re supposed to vote Republican to stick it to an elite that thinks it’s better than you.

Though it did not “sell” well enough to elect McCain and Palin at a time when the bottom was falling out of the economy, the pure politics of resentment spilled over into the Tea Party movement, which from the very beginning drank deeply from the right-wing populist well of belief in an overclass-underclass alliance of financial elites and bureaucrats and looters seeking dependence on federal benefits and the destruction of middle-class mores and virtues. One of the Tea Party’s great conspiratorial myths became viral after a Palin Facebook post argued that Obamacare would introduce “death panels” that would determine the fate of people with disabilities like her son Trig. At the peak of Tea Party influence, millions of conservatives had a tightly integrated view of Obamacare as representing an effort to cut “earned” Medicare benefits in order to vastly expand “welfare” and “socialized medicine” while attacking the sanctity of life from two directions through guaranteed, subsidized insurance for abortion services and (of course) death panels.

By the time of the 2012 campaign, Obamacare’s contraception coverage mandate became the target of a particular cultural resentment epidemic that embroiled the entire GOP: the religious liberty campaign, based on the idea that conservative Christians who viewed (against the scientific consensus) certain contraceptives (e.g., IUDs and Plan B pills) as abortifacients were being forced to subsidize homicide, and were thus being “persecuted for their faith.” The religious liberty campaign also became a pity party for those opposing same-sex marriage, with the victims being conservative elements of the wedding industry and a few TV personalities. At about the same time, a “scandal” swept the conservative media making the alleged slow walking by the IRS of applications for tax-exempt status by conservative groups who wanted to run election ads without disclosing donors into a frightful totalitarian specter of doors being kicked down and assets seized. And a remarkably large group of respectable Republicans—including new national GOP star Senator Joni Ernst of Iowa—embraced the John Birch Society’s “Agenda 21” conspiracy theory holding that local land-use regulations are part of a United Nations plot to kill private property rights.

From the point of view of constitutional conservatives (an ideological grouping that is rapidly absorbing both the Christian right and the Tea Party movement, which heavily overlap to begin with), you can add another important count to the indictment of liberal elites, bureaucrats, and their underclass clients: an unpatriotic determination to undermine rights and overthrow governing norms set down eternally by the Founders of this exceptional nation under the direct inspiration of Almighty God. So liberals were not only mocking the religion and culture of good white middle-class folk, and stealing their hard-earned money (and richly earned government benefits) to buy votes from the lower orders—they were also spitting on the foundational principles of America and defying God.

While nobody has written a full-fledged manifesto for conservative cultural resentment, Mike Huckabee’s new pre-campaign book is a significant step in the direction of full-spectrum cry for the vindication of Real Americans. It is telling that the politician who was widely admired outside the conservative movement during his 2008 run for being genial, modest, quick-witted, and “a conservative who’s not mad about it” has now released a long litany of fury at supposed liberal-elite condescension toward and malevolent designs against the Christian middle class of the Heartland.

The clever conceit of God, Guns, Grits, and Gravy is that Huckabee is explaining to powerful and arrogant elites of “Bubble-ville”—New York, Washington, and Los Angeles—the sturdy folk virtues and beliefs of “Bubba-ville,” by which he means the rest of the country, though it often sounds like just the Deep South as viewed by its older and more conservative white residents. But the book is clearly meant for “Bubbas,” and it is meant to make them very angry. The first chapter is entitled “The New American Outcasts,” and it asks readers to identify with the martyrdom of Chick-fil-A’s Dan Cathy and Duck Dynasty’s Phil Robertson for defending the “biblical” view of marriage and homosexuality. Huckabee actually launched the very successful idea of a “Chick-fil-A Appreciation Day” on his Fox News show, giving conservatives the opportunity to show their contempt for “political correctness” by giving the chicken sandwich chain a record day of sales. And he’s long competed with Bobby Jindal in promoting Phil Robertson (a Louisiana native). But aside from these totems, the idea that “Bubbas” must fight back against people who would rob them of all liberty and property permeates nearly every page of Huckabee’s book.

Huckabee very quickly (in the second chapter, on guns) introduces the idea that people like “us” may need to resort to revolutionary violence to stop the assault on our traditions. He warms to the task at the end of a chapter of rants against the Transportation Security Administration and the Internal Revenue Service:

If the Founders who gave up so much to create liberty for us could see how our government has morphed into a ham-fisted, hypercontrolling “Sugar Daddy,” I believe those same patriots who launched a revolution would launch another one. Too many Americans have grown used to Big Government’s overreach. They’ve been conditioned to just bend over and take it like a prisoner [!]. But in Bubba-ville, the days of bending are just about over. People are ready to start standing up for freedom and refusing to take it anymore.

This threat does not exactly reflect the sweet reasonableness of Jesus, but then Huckabee, an ordained Southern Baptist minister, has a bad habit of identifying Christianity with his own narrow views, without acknowledging that there are actual American “Christians”—many tens of millions of them, mostly in “Bubba-ville”—who do not share his biblical literalism or his cultural conservatism. In this respect he’s less radical than fellow culture warrior Rick Santorum, who has openly argued that mainline Protestants are no longer Christians.

But beyond the obvious culture-war issues, Huckabee has appropriated Sarah Palin’s distinctive sneering tone toward the liberal-elite enemy:

For those of us from the land of God, guns, grits, and gravy, being told we need to ride a bicycle and live in a tree stump by an environmental lobbyist in a Gucci suit or an aging hippie who hasn’t been outside the San Francisco city limits since Jerry Garcia died goes over about as well as Pee-wee Herman lecturing George Foreman on how to throw a punch.

While this sort of rhetoric is Palinesque in its hippie-punching contempt for liberals, it also hearkens back to the original model of right-wing “populist” demagoguery, George Wallace, who loved to talk about “pseudo-intellectuals” and “pointy-headed bureaucrats” riding their bicycles to work. If this is what the most “genial” Republican presidential candidate is peddling, who needs Sarah Palin?

It will be interesting to see how much Palinism-without-Palin the 2016 presidential field ultimately produces. Aside from Huckabee and Jindal and Santorum, there’s Ted Cruz, whose father, Rafael, a conservative evangelical minister, warms up crowds for his son with culture-war bromides punctuated by comparisons of liberals with communists who share an “evil agenda” for “destroying what this country is all about.” The surgeon turned politician Ben Carson has become a huge crowd favorite via a stock speech that focuses on the supposed loss of fundamental liberties to the sinister power of elites imposing rules of political correctness to suppress dissent. Texas Governor Rick Perry has managed to turn economic development into a culture-war weapon via his constant “raids” on companies in liberal states, especially California, which has replaced New York and Massachusetts in the conservative imagination as the epitome of alien territory.

And in the first big cattle call of the 2016 cycle, the Iowa Freedom Summit, sponsored by Steve King and Citizens United, the big winner was Wisconsin Governor Scott Walker for a speech in which he boasted of winning three elections in a “blue state” without compromising with his enemies, who, he suggested, had descended to making death threats against his family.

In a recent column recanting his earlier enthusiasm for Sarah Palin, the conservative writer Matt Lewis accused La Pasionaria of the Permafrost of “playing the victim card, engaging in identity politics, co-opting some of the cruder pop-culture references, and conflating redneck lowbrow culture with philosophical conservatism.” The trouble now is that she hardly stands out.

The post How Mike Huckabee Became the New Sarah Palin appeared first on Washington Monthly.

A few years ago, my wife became a funeral director. She has a special emphasis on “back to basics” funerals: simple caskets, avoiding embalming if possible, woodland burial, personal attention from the funeral director. She’d like to set up her own small funeral establishment some day, but she discovered a roadblock. New York State requires that funeral homes have embalming rooms and chapels. That means you have to have an enormous amount of start-up capital to launch a new enterprise.

This reminded me of one of the greatest myths of modern politics and policy: that the fight over regulation is usually between lefty public interest groups and free-market-oriented conservatives. On the state level, regulation is often imposed by a set of businesses to keep out newcomers.

Normally I’m against forest fires but …

Driving along a highway in New York State, I came across a sign for Donald J. Trump State Park. How is this possible???

Obama and Clinton complete each other

The Game of Thrones fans among us can’t help but speculate about the behind-the-scenes relationship between the Clintons and the Obamas. Surely these bitter rivals must be planning how to poison or impale each other. Conservatives, meanwhile, enjoy stoking a conflict, arguing that Obama has abandoned the centrism of good-ole Clinton in favor of 1970s liberalism. “President Obama has now effectively undone everything that Clinton and the New Democrats did in the 1980s and ’90s,” Michael Gerson wrote.

In fact, the Obama and Clinton presidencies complement, complete, and reinforce each other. To oversimplify, Clinton provided the policy and ideological original thinking; Obama’s the one who got the policies over the goal line.

Obama has not often been a policy innovator. Most of his big proposals were designed in the Clinton administration or by Clintonites. Obamacare was close to what Hillary proposed in 2008 and to the right of what the Clintons proposed in the 1990s. His first big environmental push was a centrist, market-oriented cap-and-trade regime. His stimulus package was almost one-third tax cuts. For all the attention to Obama’s slight weakening of the welfare law, the more striking thing is that he has pretty much left welfare reform—the most conservative thing Clinton did—intact. Many of Obama’s key aides—Rahm Emanuel, Jack Lew, Sylvia Mathews Burwell, John Podesta, Larry Summers, Susan Rice, Gene Sperling, Bruce Reed—served in the Clinton administration. That’s not including his first secretary of state. It’s a testament to how much Clinton changed the Democratic Party that even a conventional progressive like Obama ended up being “New Democrat” on most issues.

Conversely, Obama completed and expanded on the Clinton presidency in key ways. The most obvious is passing health care when Clinton couldn’t. That’s a big what-Joe-Biden-said. There’s more: Clinton started a modest-sized “direct lending” program that allowed college students to borrow straight from the government, bypassing banks; Obama got the banks out entirely, saving taxpayers billions in the process. Clinton proposed raising fuel efficiency standards for cars from 27.5 mpg to 40. He failed. Obama has successfully raised them, with a target of 55 mpg by 2015. Clinton moved the military from being actively hostile to gays to the milder-but-problematic policy of “don’t ask, don’t tell”; Obama allowed gays to openly serve.

One can debate the extent to which these achievements happened because of Obama’s skills or his timing. I think his long view, maturity, and pitch-perfect sense of when to take the big risk (e.g., jamming through Obamacare after the Scott Brown election; invading Pakistan to kill Osama bin Laden) were major factors.

But the bottom line is an impressive list of large policy accomplishments. Clinton’s legacy wasn’t undone by Obama; it was enlarged. We tend to think of Clinton as the canny pol and Obama as the visionary, but the truth is closer to the opposite. Clinton was the philosopher who reimagined progressivism in the modern era; Obama is the guy who made it happen. Clinton was the JFK; Obama the LBJ.

I don’t expect Bill or Hillary to get misty-eyed and declare, “You complete me!” But the Clintons and the Obamas have been good for each other.

What Obama and Taft should have in common

If Hillary Clinton wins, Obama should be her first Supreme Court appointment. It’d be good for her, and very good for progressives.

Would he want it? It’s possible he’d view it as too confining, but it may be the only job a former president can get that won’t seem like a step down.

Speak softly and carry a venti latte

There were many amazing moments in the Ken Burns series about the Roosevelts that ran last year. But none was as significant as this: Teddy Roosevelt drank a gallon of coffee a day. This changes everything. All this time I thought TR had a preternatural zest for life. Now we must wonder if the bursts of bully-bully-bullyness were just caffeine spasms.

Be careful in the echo chamber

In the 1980s, we bemoaned that the rise of talk radio was polarizing. The types of shows that succeeded pushed outrage and extremism, usually on the right. When cable TV exploded, we thought, Oh, good, with hundreds of channels, we’ll have a real diversity of voices. Instead, the economics of niche programming brought us Fox News and, later, MSNBC.

Then we thought the internet might at least display a fuller range of perspectives. It’s true that an almost infinite number of viewpoints can be found online, but it turns out that the same qualities that drive ratings on radio or cable drive clicks and shares online: outrage and passion.

Twitter is fueled by retweets, and strong opinions are more likely to be retweeted. Facebook’s algorithm rewards posts that prompt shares or comments. Which of these three posts is the least likely to draw comments: “Keystone will destroy the planet!,”

“Keystone will save America!,” or “Keystone may not be all that important”?

Slate did a great package on 2014 as the Year of Outrage, including this admission from the writer Jordan Weissmann: “Of the top 10 most read stories I’ve written since joining Slate, at least five of them could be characterized as outrage bait.”

As with cable and talk radio, one does not necessarily get an accurate sense of broad public opinion by hanging out on social media. For instance, Twitter reaction was 77 percent positive about Obama’s reelection. Of eight cases studied by the Pew Research Center, six showed significant differences between Twitter reaction and public opinion measured through random sample surveys.

And as with talk radio and cable, bubbles form within social media. Another Pew study found that discussion on Twitter formed around distinct, polarized communities. On Facebook, they found, conservatives are more likely to read posts that reflect their views. This all matters because social science has shown that in group situations, people’s opinions tend to evolve toward the majority view and become more rigid.

Progressives may think, Oh, good, we finally have an echo chamber of our own to counterbalance the conservatives. But just as regular Fox News viewers become detached from reality, progressives who shape their views based on what they read on Twitter will be in for a rude awakening.

Freudian slipping

My younger son came home from college after his first semester reporting that one of his favorite courses had been Intro to Psychology. “Oh,” I asked, “what did you think of Freud?”

“He didn’t come up,” my son reported. The focus, appropriately enough, was on neuroscience, which has dramatically improved our understanding of the brain. We now know that, say, depression comes from the lack of certain hormone receptors in the brain, not, for the most part, having a mom who criticized you.

Who ruined Mike Huckabee?

I’ve long felt that Fox News has done the Republican Party far more harm than good. It promotes issues like Benghazi and the IRS scandal that drive ratings but don’t appeal to a broad range of voters. It is the main overseer of the conservative bubble that insulates their leaders from actual public opinion.

There’s another way Fox News has hurt the Republicans: it ruined Mike Huckabee. I met Huckabee in the 2000s when I was running a multifaith religion website called Beliefnet. Huckabee was making the rounds promoting his efforts to encourage healthy eating. He was charming, reasonable, smart, and funny—conservative, to be sure, but empathetic and appealing. During his underfinanced campaign in 2008, he proved himself to be a far better candidate than John McCain. In a party that’s forever searching for the next Ronald Reagan, he’s the closest to the Gipper in temperament than anyone else out there.

He had troubles with the GOP establishment, however, in part because he raised taxes as the governor of Arkansas. And he once called the Club for Growth the “Club for Greed.” That independent streak was part of his appeal. He could have energized religious conservatives while seeming hopeful to the rest of the population.

Then he got a Fox News TV show. He evolved into an uninteresting, standard-issue religious-right pundit. He repeatedly said that Obama grew up in Kenya. He defended Todd “Legitimate Rape” Akin. He champions David Barton, who argues that the Founding Fathers did not believe in separation of church and state. He even mocks Michelle Obama’s healthy-eating efforts, even though being the Biggest Loser (in terms of pounds, not votes) was his claim to fame once upon a time.

He’ll still do well despite his pickup-truck-full of new baggage. He might even win the nomination with the help of his Fox fans. But thanks to having spent the last few years pickling himself in the cable TV/talk radio marinade, he won’t become president.

Priorities in order

Vox recently ran a chart based on Facebook activity showing what Americans were most grateful for. The contrasts were delightful. California thanked the stars for YouTube. South Carolinians were most grateful for salvation. And for New Yorkers? The word was “apartment.”

Obama’s sleeper legacy

One of the great sleeper legacies of the Obama administration may be another idea he got from Bill Clinton: income-contingent college loans.

Back in 1991, when Clinton talked about national service—what would eventually become AmeriCorps—his pitch actually had two parts: “Opportunity for all means giving every young American the chance to borrow the money necessary to go to college and pay it back as a percentage of income over several years, or with years of national service here at home—a domestic GI Bill.” Clinton’s main interest in loan payment reform was that people shouldn’t be forced to give up jobs in public service, if that’s their wont, because they have to pay off massive amounts of college debt.

I wrote a book, The Bill, about what happened to that applause line. The gist: In 1993, the income-contingent loan idea become subsumed in another debate about whether to kick out banks from the guaranteed student loan program. That proposal, known as Direct Lending, drew all the attention because it involved a big industry being skewered. There were rallies, AstroTurf lobbying drives, revolving-door fixers—all the elements of modern political conflict. But virtually no attention was paid to income-contingent loans—which I attempted to sex up by calling them “pay-as-you-can loans.”

Behind the scenes, the higher education community was split on loan repayment reform. Expensive private schools liked the idea; people who go to private schools tend to graduate with more debt than those who go to public schools. But public school advocates objected that it would encourage people to take on more debt and shift government resources away from needier students.

To make a long story short, Clinton got a narrow victory on direct lending and the statutory authority to start pay-as-you-can loans. But his Department of Education was not able or willing to push the payment reforms.

Flash-forward to Obama. A combination of new legislative authority (including some signed into law by George W. Bush) and more aggressive action by Obama has made the income-based repayment plans start to flower. The volume of income-based loans more than doubled from 2013 to 2014, to $102 billion in loan volume, according to the Chronicle of Higher Education.

It’s still overly complex, and there are several variants of the approach, but the key is that borrowers don’t have to pay more than 10 percent of their income. And if they are still paying after twenty years, the remaining debt would be wiped out. What’s more, if they work in government or some nonprofit jobs, the remaining debt would be wiped out after ten years.

Income-based loans don’t just help the Ivy Leaguer who wants to try Teach for America. They are also ideal for a forty-year-old parent who has decided to work part time to take care of his kids and therefore has less income to pay back loans—or a working-class student who took on debt going to school at night only to find that the customer service job he wanted has been outsourced to India. It helps not only those who choose public service but also those who struggle for reasons of global economics, family raising, or bad luck.

Implicit in all of this is a fairly radical principle: If you have tried for twenty years to make a solid income and still can’t, we’re going to give you a retroactive subsidy. Until now, financial aid was based on the income of the parents or student at the time of schooling. Under this system, a judgment about a subsidy will occur a second time, at the end of twenty years.

Did homophobia hurt traditional marriage?

The story in the current issue (“Can Gay Wedlock Break Political Gridlock?”) about the possibility for a new left-right coalition around marriage makes me wonder whether religious conservatives made a history-altering blunder when it comes to marriage policy. They were among the first to express concern about rising rates of out-of-wedlock births. In the 1980s, many progressives expressed concern too.

Then came the gay marriage debate in the late 1990s, and religious conservatives suddenly decided that was the big threat to marriage. So they spent the next decade or so trying to make the transparently silly argument that if gays embraced marriage, the institution would crumble. Had they not been blinded by their own aversion to homosexuality per se, they could have helped create an alliance with gays and other progressives around a pro-marriage agenda.

Instead, a real debate about how to improve the institution of marriage never happened. Their homophobia undermined their ability to save marriage.

In which a bureaucrat tries to find stuff out

A few years ago I did a stint in the federal government, working for the chairman of the Federal Communications Commission. The experience certainly makes me agree with the gist of the argument Lee Drutman and Steven Teles make in this issue (“A New Agenda for Political Reform”) that one of the most important, and least understood, maladies of Washington is the extent to which corporations can create a blitz of research to back up their positions.

The basic process at the FCC for finding out the truth about something is to put out a Notice of Inquiry or a Notice of Proposed Rulemaking and then read the material that industry associations, companies, or public interest groups send in. Sometimes you might take a meeting, too. Relying on material in “the public record” was thought to be more “transparent” and make policy decisions less vulnerable to legal challenge.

When we started on my project (which was about the state of the news media), we figured we should proactively do interviews. But this was such an alien concept at the FCC that we had lengthy conversations with the general counsel’s office about whether it could even be done. Wouldn’t interviews violate rules of transparency and balance?

Many of the FCC staffers were quite talented. But they didn’t have anywhere close to the bandwidth or resources to do their own research on most topics. “Objective” policymaking often amounted to a game of choosing among ideas suggested by interest groups.

The chairman, Julius Genachowski, tried to solve the problem by bringing in a gaggle of outsiders, each with their own expert networks and backgrounds. And on high-profile items, like the broadband strategy or the future of media projects, it worked. But on second-tier issues the imbalance persisted.

The crisis of statehouse reporting

That 2011 FCC report on the state of the media raised special concerns about international and local reporting. There are some signs of hope on the international side, thanks to new players like Vice and Ground Truth and the ability Americans now have to easily read journalism created by foreign publications and citizens.

On the other hand, the problems with state and local coverage have not gotten better and may have gotten worse. From 2003 to 2011, the number of statehouse reporters dropped by almost one-third. During that same time, spending by states grew from $977 billion to $2 trillion.

Newly created entities have not filled the gap, and I don’t think the commercial sector will either. The reason is scale. While ad rates online are low, publications with national appeal like Huffington Post and Politico can outrun the lousy ad rates by reaching massive numbers. But that can’t happen with coverage of the Nevada statehouse. That piece about the new ruling from the Nevada Department of Administration is just not likely to go viral.

Nonprofit news organizations will need to play a bigger role. Unfortunately, most foundations do not view local journalism as anywhere near as important as other topics. Even when they do fund journalism, nitty-gritty civic reporting isn’t the emphasis. From 2009 to 2011, five times as much philanthropic money went to journalism education as to investigative reporting.

We preempt this program …

One of the greatest special interest triumphs of the last decade has been the successful drive by the phone companies, cable companies, and other internet service providers (ISPs) to wipe out local efforts to provide municipal wi-fi. In nineteen states, they used their awesome power in the state legislature to override local programs. (Another reason we need better statehouse reporting is that special interest influence is often greater at the state level.)

On January 14, Obama urged the FCC to preempt the preemptions, and let the locals do wi-fi if they want. In response, Republicans in Congress moved to preempt the FCC’s effort to preempt the preemptions.

As policy, the Obama push is a great idea. The best way to ensure that ISPs don’t raise rates and lower service is through competition. As politics, it’s also pretty good: force Republicans to defend the phone and cable companies—perhaps the two least popular industries on the planet—in their drive to eliminate local competition.

It worked

My older son has been working in Democratic campaigns in Wisconsin while going to college and has developed important skills. A few weeks ago, I forgot to send money for college, and got the following email:

Subject line: Steven, I need your help
Steven,
I need your help now more than ever. The cost of living in Madison is rising by the day and soon, I won’t be able to support myself. With bills piling up, the future looks grim unless more supporters like you make a small contribution.
Can I count on you to make a small contribution of $500 to the Joseph Waldman for America’s Future Fund?
I live in fear everyday that I will be the next college student to fall into debt or lose the ability to afford the necessary beer and Buffalo Wild Wings that I need to survive. But with your help, I can get the support I need to live on my own and soon, get a quality job that will support your retirement.
Donate in the next 24 hours to make sure the Joseph Waldman for America’s Future Fund gets the support it desperately needs. Can I count on you to make a small contribution of $500?
Thank you for your continued support,
Joe Waldman

The politics of community college

I know there are some substantive challenges with President Obama’s proposal to make community college free. But, damn, isn’t it brilliant politics? Republicans have long cast the Dems as being only for education of the elites. By focusing on community college, Obama makes the case that higher education matters for the working class, not just the creative class. It seems tied to job success, not merely intellectual fulfillment. And requiring that the students get decent grades makes it seem tough-minded.

The X-Men voting bloc

In the not-too-distant future, the technology will be available to provide genetic enhancements before and after birth to improve your intelligence, strength, memory, empathy, bravery, and just about anything else.

My younger son, who brought this to my attention, pointed out the mind-boggling ethical implications. Naturally I went to the far more important question: Who will this help win the Iowa caucus?

The politics of genetic enhancement might not follow normal patterns. Republicans, being the Lord’s party, might be expected to take the “Don’t mess with what God gave you” position. But they’re also the free market party, and the party of the rich, so they’d also be inclined to say, “If you have the money to improve yourself, why not do it?” After all, these enhancements are just an extension of modern medicine, fundamentally no different than any life-improving/-extending techniques used today. And perhaps religious conservatives would enjoy the chance to change their homosexual fetus into a straight one.

Democrats might typically embrace a live-and-let-live philosophy. But they’d also be repulsed by the gargantuan implications for equality. If you think having better schools or SAT prep warps the notion of equal opportunity, just wait until the wealthy can buy higher IQs or better memory genes. Maybe liberals would propose making genetic enhancement a new entitlement program.

Perhaps there is a political consultant being hatched in a test tube as we speak who will figure it all out.

Mortgage refinancing and nasal cleansing

My neighborhood in Brooklyn is heavily populated by Caribbean immigrants. As in most immigrant neighborhoods, you find the occasional store created by some incredibly hardworking person offering a particularly disparate collection of services that he or she happens to know how to do.

The store closest to me offers mortgage refinancing, faxing, and nasal cleansing. Another offers an internet café, kung fu DVDs, and cell phone accessories. A third provides finger printing and driving lessons. And the one right around the corner markets “Keys made … bags of ice … send money.”

Please, gentrifiers, spare them.

“As a job creator …”

In 1999, I started an internet business that, at its peak, employed about fifty people. I never thought of myself this way, but I guess I was what Mitt Romney and John Boehner obnoxiously call a “job creator.” But the funny thing is that the success of my business was not affected by regulation, taxes, OSHA, the availability of easy loans, “uncertainty” in Washington, or any of the issues that the pro-business party emphasizes. Corporate tax cuts didn’t help my small business, because we had no profit to tax. We were just trying to break even, as is the case with many outfits. And my personal tax rate had no influence at all on how my business did.

What policies would have helped? Our fate was determined by whether consumers were spending money with our advertisers, so policies that boost consumer spending would have been most useful. Efforts to promote broadband adoption would have helped too.
Oh, and it would have been great if they could have stopped the creation of economic bubbles that then burst. When the internet bubble broke in 2001, my company almost went under, and business dropped precipitously again during the 2007 economic crisis. Loose financial regulations were bad for us.

But perhaps my situation is anomalous. I think I’ll go to the small businessman in my neighborhood who does the nasal cleansing and tax prep and ask whether their innovation has been stifled by those bureaucrats in Washington.

The post Tilting at Windmills appeared first on Washington Monthly.

The same has long been true about income inequality and wage stagnation. For years, conservatives outright denied that U.S. incomes were growing more unequal. After Thomas Piketty and other academics, not to mention the lived experience of the vast majority of Americans, made that denial untenable, conservatives shifted to the position that, even if inequality is growing, any attempt to contain or reverse it would be an unacceptable blow to “job creators.” As recently as the 2014 midterms, it was hard to find a single Republican campaigning for office on the problem of inequality and stagnant incomes.

But all that changed, with stunning speed, two months after the polls closed last November. First, Jeb Bush, as part of his unexpectedly swift entry into the 2016 presidential race, announced that the problem of reduced upward mobility for average Americans would be a centerpiece of his campaign. Soon afterward, during his aborted 2016 test run, Mitt Romney, Mr. 47 Percent himself, gave a talk bemoaning growing inequality and poverty. In short order, John Boehner, Chris Christie, Rick Santorum, Mike Huckabee, and Paul Ryan joined them in condemning the lack of wage growth for average Americans.

There was a proximate political reason for this shift. With sights now turned toward 2016, Republicans were confronted, finally, with convincing evidence of robust economic growth under Obama. So they latched on to the one lamentable figure in the data, weak wage growth, as something they could plausibly complain about. So far Republicans have shown no inclination to champion policies to fight inequality that diverge from their abiding, helpful-in-any-circumstance tool kit of tax cuts and credits. But at least both parties, for now, agree on what the major economic problem of the country is. That’s something new, and, potentially, a real step forward.

Recent polling shows that a majority of GOP voters now favor government action on climate change. So maybe that’s another area ready for a similar tectonic shift toward mutual problem recognition. I can think of at least two others.

The first is the rapid decline of marriage among middle- and lower-income Americans. Social scientists have been warning for years that this trend leads to lower family incomes and poorer life chances for children. Yet Democrats, while fighting for gay marriage rights, haven’t had much to say about the plummeting rates of heterosexual marriage. Republicans showed more vigorous interest during the Bush administration, but in recent years have mostly devoted their energies to trying to stop gay marriage. But now that the latter effort has evidently failed, argue the authors of this magazine’s cover story, each side has its own political and ideological reasons to focus anew on the problem.

The second area of possible cross-party agreement is corporate influence in Washington. Democrats have spent decades pushing for restrictions on corporate campaign contributions, which the Supreme Court keeps gutting. Meanwhile Republicans have generally seen K Street power as a feature, not a bug. But what if, instead of trying to reduce the corporate sector’s influence, Congress strengthened its ability to resist that influence by adding to its ranks of expert staff, the kind of people who can understand, and call bullshit on, the industry-funded research that is the coin of the policymaking realm in Washington? Such an agenda might well appeal to today’s Republican lawmakers, argue Lee Drutman and Steven Teles in this issue:

Even small-government conservatives are feeling pressure to do something about the influence of corporate lobbying. Improving congressional capacity is a reform action they can take that would increase their own power, wouldn’t force them to agree with liberal get-the-money-out-of-politics types, and wouldn’t directly cross the corporate lobbying community.

I’m not saying these realignments are inevitable. I am saying they are possible, given the right conditions and leadership. And like the recent GOP shift on inequality, they could happen surprisingly fast.

The post Washington’s Biggest Problem: Not Agreeing on the Problem appeared first on Washington Monthly.

Pay Any Price:
Greed, Power, and Endless War
by James Risen
Houghton Mifflin Harcourt, 304 pp.

It is no wonder, then, that James Risen, national security correspondent for the New York Times, has been in legal jeopardy with two presidential administrations of different parties. His new book, Pay Any Price: Greed, Power, and Endless War, is a chronicle of fascinating and heretofore secret stories in America’s war on terrorism. The book has a simple and arresting thesis: the longest war in America’s history is pure nirvana for the greedy and unscrupulous. Whatever the architects of the war on terrorism thought they were doing, the Iraq War’s purpose rapidly evolved within the iron cage of the Washington public-private ecology into a rent-seeking opportunity for contractors and bureaucratic empire building for government employees. Its real, as opposed to ostensible, purpose seems to be endless, low-level war. The rote appeals to patriotism are just another way of mau-mauing critics. With a theme that attacks the underlying bipartisan consensus on terrorism of the last dozen years, it is no wonder the Justice Department once contemplated heaving Risen into federal prison.

The author opens his book with a little-known operation from the Iraq War; it began immediately after the U.S. occupation of that country and continued until the summer of 2004. Air Force C-17 cargo planes transported $20 billion in cash from the vaults of the New York Federal Reserve Bank in East Rutherford, New Jersey, to Baghdad. The ostensible purpose of this cash, much of which had never been formally appropriated by Congress, was to revive the country’s shattered public services and pay Iraqi civil servants.

The program was so hideously mismanaged that $11.7 billion of the $20 billion was unaccounted for, disappeared, or was stolen. As one might expect in a Middle East culture of baksheesh, an unknown quantity was pocketed by Iraqi politicians. But another, also undetermined, amount was skimmed by mid-level and junior U.S. military officers in charge of counting and distributing the cash; Risen mentions the cases of some who were caught depositing suspiciously large sums in their bank accounts in the United States.

Unfortunately he says nothing about the senior officers who had extraordinary discretion over much of the cash under the Commander’s Emergency Response Program. I recall generals trooping to Capitol Hill throughout the mid-2000s to sing the praises of CERP; the reader can imagine just how popular a pallet of cash not subject to the accountability clause of the Constitution would be! A congressional colleague of mine at the time who had just come from a job at the Treasury Department told me that some U.S. personnel in Iraq amused themselves by tossing shrink-wrapped packets of $100 bills back and forth as if they were Nerf footballs.

War, of course, is synonymous with waste, as procurement boondoggles stretching back to the War of Independence attest. But the war on terrorism is in a class by itself. Greatly abetted by then Secretary of Defense Dick Cheney’s blanket outsourcing of military logistics in 1992, the money spent on war has become a gold rush for private, largely unaccountable contractors.

The same holds true in the intelligence community: about 70 percent of the National Security Agency’s budget is spent on contracts. That, combined with the fact that the revolving door to a corporate board seat beckons senior agency officials, means the pull is always toward waste, fraud, and abuse. Former NSA insider Thomas Drake, who blew the whistle on a gold-plated contractor program and was charged under the Espionage Act for his pains, told me last year that his old agency is “literally helpless” without contractors.

It is hardly surprising that the hundreds of billions of dollars funding the war on terrorism will tempt the acquisitive instincts of contractors and their agency counterparts. But it is up to senior officials in the executive branch to exercise oversight and discipline over the process. Oversight is also a key constitutional function of Congress. Risen documents that such oversight is still almost totally lacking. He notes that the administration of George W. Bush habitually obstructed the special inspector general for Iraq reconstruction (SIGIR), Stuart Bowman, who tried to do his job in uncovering fraud and theft. In 2010 Bowman finally tracked down $2 billion of the lost cash: it was in a bunker in Lebanon. Incredibly, the Obama administration did not grant his team clearance to enter Lebanon to continue the pursuit.

What about Capitol Hill, and particularly those gimlet-eyed Republicans whose core philosophy is that government cannot run a lemonade stand, and who mercilessly exposed Solyndra, the General Services Administration’s junkets, and purported waste in the stimulus bill? Rather than exposing waste in the war on terrorism and clawing back the money, GOP lawmakers have exacerbated the mess by throwing more money at the agencies than they could ever spend wisely, assuming wisdom were even present. They are also not terribly interested in bad-news stories about anything that falls under the rubric of national security.

In February 2006, Secretary of State Condoleezza Rice testified before my employer, the Senate Budget Committee, on the State Department’s budget, and much time was spent on the state of reconstruction in Iraq. The secretary began to reel off impressive statistics on the rebuilding of the water, sewer, and electric power systems. At that point ranking Democrat Kent Conrad sharply questioned her based on a leaked draft SIGIR report refuting her optimistic presentation of reconstruction in nearly every particular.

The hearing was finally getting interesting: Rice’s voice fell into that nervous tremolo that we all previously heard when the 9/11 Commission caught her in a less than truthful statement. Nearly instantly, however, the chairman, Republican Judd Gregg, normally an indefatigable fiscal conservative and rooter-out of waste, gaveled the hearing to a premature ending, thereby relieving Condi of her torment and the public of the full story. The next day, I learned from a colleague that as soon as Rice had returned to the State Department from her inquisitorial tribulation on the Hill, Bowen started receiving pressure to withdraw the report.

The true state of Iraq reconstruction was vital for policymakers to learn: not only did the lack of clean water and reliable electricity make Iraqis’ lives miserable; the absence of power meant businesses could not operate and more people were thrown into the swelling ranks of the unemployed and disaffected. Many of those people began to see the Americans as hostile occupiers rather than liberators, and it is not surprising that the growing insurgency targeted them for recruitment.

The syndrome the Bush administration created in Iraq was what former Pentagon critic Chuck Spinney has called a “self-licking ice cream cone”: the measures to fight the war on terrorism guaranteed more terrorists, which in turn guaranteed the agencies more money to fight the war on terrorism. The same process was at work with respect to torture and drone strikes. It is a great business model for contractors and bureaucratic empire builders, but far less favorable as a national survival strategy.

Readers may remember that during the first years after 9/11 a few “terrorism experts” that the cable news channels always give credence to were claiming that al-Qaeda’s propaganda videos might contain tiny alphanumeric and bar codes buried within the pixels; presumably these were coded messages to followers about planned terrorist attacks. Then, after a while, the story faded away. Why?

The story was the sliver that leaked into the public media from what Risen describes as a super-secret program that hoodwinked the Central Intelligence Agency, the Department of Defense, and the White House. The idea was hatched by Dennis Montgomery, a problem gambler with casino debts, and financed by Warren Trepp, a former partner of junk bond king Michael Milken. Neither had experience with defense, intelligence, or IT, but they partnered to develop pattern-recognition software that could supposedly detect messages within video images.

This was manna from heaven for the CIA’s Directorate of Science and Technology (S&T), which had played a lead role during the Cold War but had been sidelined by the war on terrorism. They could finally get in the game, and their desire to be relevant swamped their common sense. Montgomery deceived them in test demonstrations that were much like conjuror’s tricks—Montgomery the gambler was always looking at ways to beat the house.

The S&T directorate sold the program to the CIA leadership and the White House. Risen tells us that John Brennan, the current CIA director, whose dishonesty became notorious during the Senate’s torture investigation, was a fan of the scheme. At one point CIA director George Tenet was feeding the raw—and worthless—data to President Bush, who had to act as his own intelligence analyst.

Even when the CIA leadership finally cottoned on to the fraud, such was their embarrassment that they kept the whole fiasco secret. Prosecuting or debarring Montgomery was out of the question, so he merely continued peddling the hoax to other agencies. The Defense Department’s Special Operations Command fell for the con, paying Montgomery’s company $10 million for the software to aid in automatic target recognition so that the sensors of Predator drones could detect targets to assassinate. Since this worked no better than decoding al-Qaeda’s fictitious secret messages, the Defense Department quietly dropped the program, but kept up a veil of secrecy to hide their own embarrassment.

How could government agencies with a vast network of research labs and armies of science PhDs fall for a technological hoax as elementary as the “Mechanical Turk” of eighteenth-century Europe or the hundred-miles-per-gallon Fish carburetor of the 1950s? There are several factors: the long-standing American bias toward technological panaceas; the bureaucratic competitiveness of the S&T directorate, which wanted to enhance its role in the war on terrorism; and the smothering blanket of government secrecy, which prevented other agencies from learning of the hoax.

There is, however, something more to it that Risen does not explain in his thoroughly disillusioning volume about what goes on in the boiler room of the ship of state as it sails to meet the terrorist foe. The attacks of 9/11 seem to me to have unhinged a significant portion of the American population, particularly those occupying influential positions such as the news media. Government officials, who follow the mob rather than lead it, showed the same psychological symptoms in aggravated form. Disoriented and emotionally labile in the wake of 9/11, they were easy marks for the greedy contractors and out-and-out con men that Risen profiles. As he says, “They are the beneficiaries of one of the largest transfers of wealth from public into private hands in American history.”

Risen unfortunately almost loses the plot in a long middle chapter about private intelligence operations that the lay reader may find hard to follow for want of more interpretation by the author. He does reveal, however, the convoluted and confused methods of U.S. intelligence operations, where it is difficult even—or perhaps especially—for intelligence officials to know who is working with us and who is against us. Risen points out how national security objectives are undermined by competitive and sometimes acrimonious rivalry between the Federal Bureau of Investigation and the CIA, reminding one of the jealousy between the KGB and the GRU (Main Intelligence Directorate) in the former Soviet Union.

Contrary to popular belief, wealth in the Middle East no longer comes only from oil. Risen shows us how the geyser of post-9/11 American money is financing hordes of Middle Eastern arms dealers, informers, money launderers, mafiosi, and not a few terrorists. Risen rubs in the implication that minimum-wage jobs in the United States are the price Americans pay for villas in Beirut and Amman.

The author ends with the contention that the goal of the war is endless war. He does not go into the analysis, but I believe that there are strong structural grounds supporting his claim. During the Cold War, the prospect of open conflict with the Soviet Union was so catastrophic that no one, not even the arms industry, wanted war. What they wanted was a surrogate war: an arms race. America stayed at peace, but defense budgets rose with each new claim of ten-foot-tall Russians. That process was reflected in high procurement budgets that were of interest to the major contractors, while the operations budget, which was mainly an internal Defense Department interest, lagged in comparison.

With the broad outsourcing of operations accounts (the budget that pays for maintaining an army fighting in the field, a budget that grows rapidly during war), contractors now have an incentive for endless low-level war. Someone may have made the cynical cost-benefit analysis that the less-than-existential national stakes and the relatively low casualty rate—6,000 U.S. military dead in thirteen years of war amount to only a third of U.S. dead from the one-month-long Battle of the Bulge—make a prolonged war on terrorism an acceptable business model. And contractor involvement is not only logistical—companies like Blackwater have been involved in actual shooting.

It is difficult to read Pay Any Price and not come away with the sick feeling that the Bush presidency—which, after all, only assumed office by the grace of judicial wiring and force majeure—was at bottom a corrupt and criminal operation in collusion with private interests to hijack the public treasury. But what does that say about Congress, which acted more often as a cheerleader than a constitutional check? And what does it tell us about the Obama administration, whose Justice Department not only failed to hold the miscreants accountable, but has preserved and expanded some of its predecessors’ most objectionable policies?

Partisans may squabble over the relative culpability of the Bush and Obama administrations, as well as that of Congress, but that debate is now almost beside the point. If Risen is correct, America’s campaign against terrorism may have evolved to the point that endless war is the tacit but unalterable goal, regardless of who is formally in charge.

The post Operation Rent Seeking appeared first on Washington Monthly.

The Conversation:
A Revolutionary Plan
for End-of-Life Care
by Angelo E. Volandes
Bloomsbury USA, 240 pp.

A series of medical emergencies, small and large, had landed him in the hospital multiple times over the previous decade. A side effect from a cholesterol drug led to kidney failure and three weeks in the hospital on dialysis. There was a small stroke, and then another. He was hospitalized for constipation that over-the-counter remedies could not resolve.

Many of these ailments meant a trip over the Coast Range to the big hospital in Portland, Oregon, where the doctors and nurses are caring, but the indignity and pain left Mick loathing every second he spent there. During his previous stay, he fumed that the nurses insisted on accompanying him to the toilet to prevent him from falling. “I can’t even take a piss on my own!” He outsmarted them by perching on the edge of the bed and using a urine bottle, a trick that was probably more likely to lead to a fall than if he shuffled the ten steps to the bathroom on his own. Once he returned home, he told me, my brothers, my stepmother, and anybody else who would listen that he never, ever wanted to be in that hospital again.

In November 2013, however, he developed a volvulus, a loop in the gut that at first shows up as constipation and vomiting but if left untreated often leads to a section of the bowel dying and the patient developing a fatal infection. My brother took him up the coast to the community hospital, where the loop in his bowel was straightened out with a simple procedure. They could have kept him there overnight to see if the volvulus developed again, but the emergency room doctor said Mick might be having a small heart attack and he didn’t “feel comfortable” keeping him there. He wanted him to go to the hated big hospital in Portland. Keep Mick away from Portland, I urged my brother on the phone from my home 3,000 miles away. No chance. Into an ambulance Mick was bundled for the bumpy ride across the mountains. So much for respecting the wishes of the dying.

Once in Portland, my father’s new set of doctors began “working him up.” Blood was drawn, vital signs taken. He was assigned a young hospitalist, a primary care doctor employed by the hospital to interact with the family and coordinate the various specialists involved in my father’s case. Shortly after arriving, Mick suffered another volvulus, which was again resolved with a quick procedure. But now it was apparent that this was probably going to keep happening. The only treatment for recurrent volvuluses is abdominal surgery.

There was almost no possibility that Mick would emerge from major surgery in any shape to leave the hospital, much less resume his old, already much diminished life at home. On the phone again, I urged my brother to ask for a consult with the palliative care team. These doctors are trained to relieve symptoms and help patients and families understand their choices when a patient is seriously ill. Yet when my brother requested the consult, the hospitalist replied, “We aren’t there yet.” In other words, in the hospitalist’s (erroneous) view, palliative care was strictly for the dying, and my father wasn’t yet at death’s door, just in the waiting room.

By the time I got to Portland, a cardiologist had succeeded in giving Mick a useless nuclear stress test to determine if his heart was fit enough to have a surgery that the rest of his body could not withstand. Once that was done, the surgeon confirmed that my father was not a candidate for surgery. Now, finally, the hospitalist was willing to call in palliative care, but not before he managed to hook my father up to something called “total parenteral nutrition,” an IV line that delivered a milky glop that did nothing but prolong his dying.

Curing Medicare: One
Doctor’s View of How Our
Health Care System Is Failing
the Elderly and How to Fix It
by Andy Lazris
CreateSpace Independent Publishing
Platform, 290 pp.

The one bright spot in my father’s stay was his nurse, Eric, a former military medic who offered respect and humor. Mick wasn’t talking a lot, whether from weakness or anger at being in the hospital or some combination, but he would answer Eric’s questions.

One day, when my youngest brother was there, Mick sat up in the bed, grasped my brother by the wrist, and looked him in the eye. “Take me home,” he said. “I’m ready to die. I just want to go home.” My brother could see that our father was desperate to get out of there, and his eyes welled up. “Dry your tears,” Mick said, “I’m done.”

A little later, Mick began struggling with the bedclothes, trying to swing his legs over the edge of the bed. This set off an alarm in the nurses’ station, sending Eric into the room. “Mick,” he said. “What do you want?”

“A head start,” replied my father.

Before Mick died, I knew on an intellectual level that we do death badly in America. Only 19 percent of Americans die at home, which is where the vast majority of us want to spend our last days. Most of us die in the hospital or nursing home. I recently helped produce a report on dying in California which found that in parts of Los Angeles, one in six patients with terminal cancer receive chemotherapy, are put on a ventilator, or receive some other form of “life-sustaining” (that is, death-prolonging) treatment in the last month of life, despite the fact that the American College of Oncology says it’s bad medical practice. I knew that magical thinking by patients and families contributes to the insanity of futile care. A survey conducted about a decade ago found that 35 percent of Americans believe that any disease can be cured with enough money and the right doctors. In other words, death is optional. But knowing the statistics is one thing; it’s quite another to understand, and feel, the suffering a medicalized death so often entails, on the part of both the dying and the surviving.

By now, many more Americans have begun to gain such an understanding, from reading Atul Gawande’s moving and lyrical Being Mortal: Medicine and What Matters at the End. Published last fall to great acclaim, including a glowing review in these pages (Phillip Longman, “The American Way of Dying,” November/December 2014), Being Mortal movingly depicts many of the indignities visited upon the dying.

But two other books by physicians are needed to round out a clearer view of why we have made such a mess of death, and what we can do about it.

In The Conversation: A Revolutionary Plan for End-of-Life Care, author Angelo Volandes’s telling of seven deaths eloquently illuminates both how and why we fail the dying. One is the story of Taras Skripchenko, a Ukrainian immigrant with no family, dying of inoperable lung cancer. Volandes was a young resident, still in his training when Skripchenko was admitted to the hospital from a nursing home. The patient was in the final stages of multiple chronic conditions but was too delirious to direct his own care, and thus was automatically placed on “full code,” meaning do everything to delay death.

Volandes was in a cramped elevator with his preceptor, a senior resident just a couple of years older, when Skripchenko, whose heart had stopped just a little while earlier, went into cardiac arrest. The younger doctor climbed up on the gurney to straddle their unconscious patient to do chest compressions, breaking ribs in the process. Volandes tried, unsuccessfully, four times to remove the fluid from the sac around Skripchenko’s heart with a long needle inserted between the ribs. Finally, the patient was placed in the ICU, where he was hooked up to eight different IV lines and tubes, including a urinary catheter, a rectal trumpet tube, and a tube that snaked through a hole cut into his chest to drain the fluid around his heart. Skripchenko would linger another two weeks in the ICU, never regaining consciousness before he died.

After delivering their patient to the ICU, Volandes voiced feelings of misgivings to his preceptor. “Perhaps it was because I was a young doctor,” he writes, “not yet numbed to the brutal experience of caring for hundreds of patients.” The senior resident replied, “We did everything by the book. Look, this is the system. We have a job to do.”

“End-of-life care is broken at every level,” writes Volandes, and patients and their families are largely in the dark about what awaits them at the end of life at the hands of the health care system. This lesson was conveyed to him by another patient, an intelligent, highly educated woman who was dying of cancer, about whom Volandes told me in an interview two years ago. On call late at night when she was admitted, Volandes asked her if she had thought about how she wanted to be treated as she approached death: Did she want comfort care? CPR? Intubation? She told him she didn’t know what she wanted—because she had no idea what he was talking about. In a moment of inspiration, he decided to show her. He wheeled her upstairs to the ICU, where a patient happened to be having a ventilator tube removed. Afterward, she looked at Volandes and said, “Whatever that was, I don’t want it.”

The doctor says, “Do you want us to do everything for your mother?” The family hears, “We can save your mother’s life.” Volandes began to perceive the gulf that lies between what doctors say and what patients and family members imagine. Over the next decade, he created a series of short videos intended to bridge the gap. Each video describes in simple terms and images what end-of-life care entails.

For example, one three-minute video shows a woman in the advanced stages of dementia, while the narrator describes the typical course of dementia, which inexorably robs sufferers not just of memory, but also the ability to speak, understand simple questions, and perform such tasks as eating and going to the toilet. Another shows a patient on a ventilator, or breathing machine, as the narrator slowly and simply explains that a tube will be inserted into the trachea, and the patient must often be sedated and cannot speak. Each video includes easy-to-understand statistics about, for example, how rarely frail, elderly people get off a ventilator and actually go home. (Full disclosure: The videos are narrated by Volandes’s wife, Aretha Delight Davis, also a physician and a member of the board of my organization.)

The proof that seeing is understanding lies in a series of rigorously controlled studies Volandes has done with funding from the National Institutes of Health. In one study, published in 2010, two groups of terminal cancer patients either were shown a video or heard a verbal description of their end-of-life choices (the words in both the film and the description were the same). Of those who saw the video, more than 90 percent chose comfort care, versus 22 percent who heard only the words and opted for greater medical intervention.

Like The Conversation and Being Mortal, Andy Lazris’s Curing Medicare: One Doctor’s View of How Our Health Care System Is Failing the Elderly and How to Fix It weaves the stories of patients throughout a larger narrative. It is also a cri de coeur from a geriatric specialist who wants desperately to care for his elderly patients with compassion and kindness, but finds himself thwarted at every turn by an overzealous medical culture, irrational regulations, and perverse Medicare payments that too often make sending patients to the hospital the easiest option.

Curing Medicare is passionate, smart, and a little terrifying. Lazris tells of patients with minor conditions who, once in the hospital, become agitated and must be “restrained”—doctor code for tied to the bed by the wrists—to prevent them from pulling out tubes or getting out of bed. Their care is overseen by young hospitalists (like my father’s doctor), few of whom, writes Lazris, “are cognizant of how to care for the elderly. They call in a squadron of specialists, tackling one problem at a time. The end result is aggressive care.”

One of his patients, a Mrs. R, was sent by a cardiologist to the hospital for a rapid heartbeat—a minor condition that Lazris would have treated in his office and then ordered a home health nurse to monitor for a few days. The family decided to follow the cardiologist’s recommendation, in part because Medicare would not pay for a home health nurse, one of the many ways Medicare reinforces bad care.

Once admitted, Mrs. R was found to have a little fluid on her lungs. She was prescribed an intravenous diuretic, but the dose was too high, causing her to become incontinent. She became dehydrated, and her blood chemistry was thrown off. She lost sleep and grew delirious. She was “restrained” and given medication to calm her, but she grew more agitated, and then unable to eat or drink, which caused her kidneys to fail. The nurses pushed liquids and food on her, which she inhaled, causing a raging pneumonia that necessitated a trip to the ICU. There she was put on a ventilator, lost blood, and developed an infection that caused intractable diarrhea. She lasted two weeks before dying.

Lying just below the surface of these three books is a set of political decisions with which the United States will be forced to grapple in coming decades. When a frail, elderly person gets sick, takes a fall, or has trouble breathing, it’s as if they have stepped onto a slippery chute leading straight into the hospital, no matter how fervently they and their families might wish to avoid invasive treatment as they age and approach death. That’s because hospital services are what our medical industrial complex has been built to offer, and delivering invasive end-of-life care is the job for which we have trained our doctors and nurses. Medicare policy, federal subsidies for hospitals, and taxpayer dollars for medical training all have helped create a technology-rich, hospital-centric system.

What we don’t do is train clinicians to talk to patients, and what we don’t have is the community-based infrastructure for delivering “high touch” care to people where they live. We don’t provide the simple services, like regular meal delivery and aides to help with housecleaning and bathing, that can help an elderly person preserve some autonomy and dignity. We don’t have enough primary care doctors practicing in the community—in part because our teaching hospitals make more money when they train more specialists—and the primary care doctors we do have are too busy to make house calls. Of course, there’s always an assisted-living facility— for those who can afford the $3,000 to $6,000 a month. For the rest of us, once we can no longer perform the simple tasks of daily living, like cooking for ourselves, or toileting, we can either move in with the kids or go to the nursing home.

Policymakers should heed Lazris’s list of the Medicare regulations that should be modified or scrapped. For instance, we should get rid of the rule that says a patient has to stay in the hospital for at least three days before being eligible for a skilled nursing facility. We should pay for home nursing for people who need a little temporary help but don’t need to be hospitalized. Beyond that, as a nation we are going to have to acknowledge our overinvestment in hospital-based care and underinvestment in communities, and recognize that few mechanisms currently exist, including Obamacare, for reversing them.

It took my family ten days to pry Mick out the hospital and get him into home hospice. Mick took another ten days to die. We eased the dryness of his mouth with ice chips. He asked for and got a sip of beer in the afternoons when friends visited. “That tastes good!” he would say. He slept more and more each day, and responded more infrequently to questions or a squeeze of his hand. Right until the end his eyes remained the clear blue of glacier ice. When he died, my stepmother and I dressed him in his best Japanese kimono, and then we sat with family in the darkening living room, as the surf boomed on the shore, drinking champagne and alternately weeping and laughing as we retold every funny story we could remember from the life of a great artist and complicated man. Dying is hard. The epidemic of futile, indifferent, often harmful medical intervention that has infected American health care makes it even harder.

The post Death with Indignity appeared first on Washington Monthly.

The Last Beach
by Orrin H. Pilkey and
J. Andrew G. Cooper
Duke University Press Books, 256 pp.

Such efforts have proved popular with residents of beachfront communities. But Pilkey, who is a professor emeritus of geology at Duke University, and Cooper, a professor of coastal studies at the University of Ulster in Northern Ireland, argue that the effort is increasingly futile at a time of rising sea levels, when each fresh infusion of sand lasts only a few years and the cost of replenishing beaches has risen sharply.

Consider, for instance, how often some American beaches have had to be replenished. Wrightsville Beach, near Wilmington, North Carolina, Pilkey and Cooper point out, has had more sand added to it nineteen times since 1965. Carolina Beach has been restocked twenty-eight times. Hurricane Sandy made even more federal money available for replenishing beaches. To take one example I discovered in my reporting for ProPublica: contractors for the Army Corps of Engineers added more than 1.8 million cubic yards of sand to the beach in Ocean City, New Jersey, in 2013, with the American taxpayer footing most of the $18 million bill. It wasn’t the first time the town had benefited from federal largess. In the past twenty years, on nine separate occasions, Washington has moved nearly twelve million cubic yards of sand to Ocean City beaches, according to data compiled by Western Carolina University’s Program for the Study of Developed Shorelines, to the tune of $40 million.

The Last Beach is a broad survey of the threats facing the world’s beaches as sea levels inch up and after decades of unrestrained building on coasts from Miami Beach to Málaga. “Beaches in nature are almost indestructible,” Pilkey and Cooper write. They bounce back astonishingly quickly even after devastating storms. When a tsunami hit the Indonesian island of Sumatra in 2004, for instance, the beaches on the Banda Aceh coast seemed totally destroyed, as the coastline moved more than 325 feet landward overnight. But satellite images taken a little more than a year after the tsunami show a wide, newly formed beach along the eroded coastline. Natural beaches can also survive rising sea levels. In the early 2000s, a marine geologist named Andy Green discovered a series of preserved dunes 200 feet below sea level off the coast of South Africa—the remnants of an ancient beach. The beach had been drowned when the sea level rose rapidly about 11,500 years ago. Natural “beaches have been able to survive more than 325 feet” of sea-level rise since the last ice age, Pilkey and Cooper write—orders of magnitude greater than the height the oceans are predicted to rise in the next century.

These beaches shifted with the coastline. But it’s impossible for beaches to move when they’re lined with boardwalks and oceanfront high rises, as they increasingly are around the world. The “rush of civilization to the shore that we have witnessed in our lifetime has been quite unlike anything that occurred in the past,” Pilkey and Cooper write. The result: a growing number of seawalls and other fortifications to protect beachfront property—and growing costs to the American taxpayer to maintain them. “Seawalls are the beach’s deadliest enemies,” the authors write, “preventing their landward migration and causing them to be squeezed out as sea level rises.” In the coming decades, Americans will have to decide whether they want to preserve the nation’s beaches or the buildings behind them; they cannot have both.

There’s no real narrative running through The Last Beach. Instead, the book is organized into chapters laying out the various ways in which humans have maimed the world’s beaches. There are a lot: dams such as the Elwha Dam in Washington State—which was blown up in 2011—have cut off the flow of sediment that feeds many beaches. Illegal sand mining has depleted beaches from Morocco to Malaysia. Increasing amounts of trash are accumulating on beaches. Beach pollution is also increasing, and while the water along beaches is often tested, the beach sand itself is not. “Walking barefoot, lying directly on beach sand, and particularly, being buried in the sand may now be hazardous activities for beachgoers,” Pilkey and Cooper write.

Pilkey—whom the New York Times Magazine described in 1988 as “America’s foremost philosopher of the beaches, the sea bottoms and the coastal sands”—has taught at Duke for half a century, and he has coauthored more than two dozen books on beaches and coasts. The Last Beach is sprinkled with fascinating trivia about beaches around the world. Who knew, for instance, that the turtle eggs found on the beaches of Ras al Hadd in Oman can make up 95 percent of the diet of the Arabian foxes there? Or that 700 truckloads of illegally mined beach sand “cross the bridge from Singapore to Malaysia every day”? And if the book is not exactly stylishly written, it is clear and readable, particularly for an academic volume. Phrases such as “multi-decadal time frame” thankfully pop up only rarely.

The Last Beach is determinedly international—it dives into the full range of challenges facing beaches around the world. But the broad focus means that Pilkey and Cooper don’t delve into the public policy decisions that have encouraged risky construction along the shoreline in the U.S. A federal law called the Stafford Act, for instance, commits Washington to paying at least three-quarters of the cost of repairing infrastructure damage after storms. In 2012, the New York Times reported that the law had caused the federal government to shell out more than $80 million, adjusted for inflation, since 1979 to patch up the tiny community of Dauphin Island, Alabama. That’s more than $60,000 for each of the island’s 1,300 permanent residents. The heavily subsidized National Flood Insurance Program has paid an additional $72 million to Dauphin Island homeowners. Pilkey called the situation on the island a “scandal” in the Times story, but neither the Stafford Act nor the flood insurance program earns a mention in the book.

Pilkey and Cooper devote a few pages to the influence of what might be called the coastal engineering industrial complex—the big international engineering firms that compete for government contracts to build seawalls and other fortifications that the authors argue destroy beaches in the long run. They also mention the American Shore and Beach Preservation Association, a lobbying group that promotes beachfront development and has championed beach replenishment. But they don’t go into depth on how, exactly, companies and lobbyists have influenced the public policy discussion surrounding beaches.

What’s the way forward for beaches, then? Pilkey and Cooper’s predictions are grim: “We believe that the current outlook, biased toward protection of property, will inevitably lead to a worldwide loss of beaches lined with development.” Artificial stone steps descending into the water and strips of sand behind seawalls will become increasingly common along developed coastlines, they suggest. Increased pollution will likely mean rules against walking barefoot on some beaches, even if such rules seem unthinkable today.

Pilkey and Cooper do point to a few promising examples of government reforms. Britain’s National Trust, for instance, which owns about 10 percent of the coastline in England, Wales, and Northern Ireland, has adapted buildings to rising waters in recent years and has resisted calls for constructing seawalls. In the U.S., the National Park Service has banned coastal engineering along national seashores since 1972, and some states bar hard defenses such as seawalls. But the authors also hint at the political obstacles to saving beaches in the U.S. “Since local communities almost always prefer beach loss to building loss, the retreat option must be governed and enforced at a higher level of government,” they write. But which specific policies might achieve this, they do not say.

The post Welfare with an Ocean View appeared first on Washington Monthly.

George W. Bush
by James Mann
Times Books, 208 pp.

Here, as is sometimes the case, the genre dictates the form: the biographies are supposed to conform to a standard: they should be “meditation-length biographical essays” that distill the “life, character, and career” of each president while focusing primarily on their time in the White House. This is not a polemical book.

That in itself presents a challenge to the author who must contend with a presidency and an era in which the definition of reality itself had become contentious.

On the whole, however, James Mann has done a commendable job of recounting the early life of George W. Bush, his rise as a politician, and the major events and decisions of his two terms as president. Mann maintains an evenhanded tone without being non-committal about the countless controversies that arose during Bush’s presidency. At the same time, to his credit, Mann doesn’t allow the imposed format to force him into an uninteresting recitation of facts.

The Bush presidency was birthed on television as the nation sat riveted to images of poll workers examining hanging chads during the recount in Florida, a painful process that was ultimately short-circuited by the Supreme Court’s ruling in Bush v. Gore. When the country and the courts cannot even agree on what constitutes a vote or who actually won an election, it doesn’t augur well for a dispassionate interpretation of a presidency.

Even those who are familiar with Bush’s basic biography and paid close attention to politics during his terms in office will find insights, both trivial and substantive, that help flesh out their understanding of the forty-third president and his administration. The reader will be interested to learn, for example, that when he graduated from flight school in the Texas Air National Guard it was his father who pinned his wings on him and gave the commencement address. Or, that during the Florida recount, Bush spent his time at his Crawford, Texas, ranch, which did not yet have any cable or satellite television. With little details like this Mann keeps an otherwise familiar and dispiriting narrative fresh.

The opening chapters familiarize the reader with the Bush clan and W.’s life and experiences from birth through his two terms as governor of Texas and “election” as president. While Mann treads lightly around controversies like Bush’s alleged time AWOL during his service in the Alabama National Guard (never mentioning the name Dan Rather, for example), he pulls no punches in describing Bush’s period as a self-described “boozy kid.” At Yale, Bush served as president of Delta Kappa Epsilon, a fraternity known for its conspicuous alcohol consumption, and he organized the frat’s first-ever toga party. Mann writes,

The first time George W. Bush’s name ever appeared in the New York Times, it was to defend his fraternity. In 1967, amid the turmoil of the antiwar protests sweeping college campuses, the Yale Daily News reported that DKE had ‘branded’ forty of its new recruits by applying a hot coat hanger to their backs in a way that singed into the flesh the Greek letter Delta.

In another account, Mann notes that Poppy Bush only learned that George had been accepted to the Harvard Business School when Jeb told him, in an effort to defuse a confrontation over George’s drunk and belligerent behavior. As Mann has it, Jeb hoped to show his father that George “was not the ne’er-do-well he may have seemed.”

As we know, the turning point for George didn’t come until he turned forty, gave up drinking, and (with the help of Billy Graham) found religion. Mann doesn’t miss the connection between George’s sudden interest in sobriety and religion and his father’s intention to run for president in 1988. As early as April of 1985, the whole family had been summoned to Camp David, and the campaign strategist Lee Atwater warned all the children that they would be heavily scrutinized by their father’s rivals. Mann notes that Bush’s wife, Laura, and his longtime friend Joe O’Neill have both remarked that a desire not to embarrass the campaign was a major factor in his decision to put down the bottle. The influence of evangelical conservatives had been growing within the Republican coalition, and Bush Sr. had a strained relationship with them. Barbara Bush had even referred to some evangelical leaders as “these fakes.” For Mann, this made George’s “conversion” a valuable device that gave the campaign an in with this important voting bloc. When the campaign put one of the televangelist Jim Bakker’s aides on the staff, George W. became his minder. This interpretation of Bush’s turnaround is as close as Mann comes to being cynical.

Interestingly, it wasn’t Bush Sr.’s election as president but his defeat that opened the door to W.’s political career. Once the Bushes and Karl Rove orchestrated the defeat of Texas Governor Ann Richards, it was but a short step from the Austin statehouse to the White House. Mann writes,

Politically, the details of Bush’s performance as governor did not matter all that much. His name was Bush and he was the Republican governor of the nation’s second-largest state; those facts alone made him a likely presidential contender. Later, after he won the Republican presidential nomination, a reporter asked his father to explain George W.’s rapid ascent. The former president replied that once his son became governor of Texas, “It’s a six-inch putt.”

Mann breaks down Bush’s first term in office, unsurprisingly, before and after 9/11. As Mann notes, “the most consequential piece of domestic legislation of Bush’s entire tenure in the White House was enacted less than five months after he took office.” This was Bush’s first round of massive tax cuts for the wealthy. It was a legislative victory that came with devastating short- and long-term costs. In the short term, the process so alienated Republican Senator Jim Jeffords of Vermont that he decided to caucus with the Democrats, taking control of the upper chamber away from the Republicans. In the long term, Bush’s tax cuts squandered the surplus, ran up enormous deficits, and led to the greatest income inequality the country had seen since the eve of the Great Depression in 1929.

Up to this point, the book reads much like any other presidential biography, but things take a sharp turn once 9/11 and its aftermath arrive. Mann recounts the harrowing events of 9/11, noting that Dick Cheney appeared to take charge of the nation’s emergency response, leaving the president looking like he was out of the loop.

The full implications of the Bush administration’s initial reactions to the attacks, from the passage of the Patriot Act to the opening of the detention camp at Guantànamo Bay and the launching of “enhanced interrogations” to the dark prisons and warrantless surveillance, would not be thoroughly known and understood until his second term in office and beyond. In what remained of his first term, everything would revolve around the decision to invade Iraq and depose Saddam Hussein.

“Overall, the Iraq War now seems like a strategic blunder of epic proportions, among the most serious in modern history, and it is difficult to see how future historians can decide otherwise,” writes Mann. In his chapter dedicated to Iraq, Mann notes the faulty assumptions and poor planning that led to this epic blunder, but he doesn’t give full treatment to the magnitude of the deception. There is no mention of Douglas Feith’s Office of Special Plans and the stovepiping of intelligence. Or the role of the New York Times reporter Judith Miller in disseminating propaganda from the vice president’s office. We read nothing about Homeland Security Secretary Tom Ridge’s color-coded terror charts and advice that we all buy bottled water, plastic sheeting, and duct tape to protect ourselves from weapons of mass destruction.

That the war (or, rather, the occupation) wasn’t going at all as planned was temporarily mitigated in late 2003 when Saddam Hussein was captured. But when the Abu Ghraib prison scandal broke in April 2004, Bush claimed to be blindsided. According to Condoleezza Rice, “We never recovered fully.” It was around this time that Bush’s foreign policy team began to come apart at the seams. Secretary of Defense Donald Rumsfeld and Secretary of State Colin Powell both attempted to resign, and Cheney offered to be left off the 2004 ticket. Meanwhile, nearly two dozen officials at the Justice Department, Central Intelligence Agency, and Federal Bureau of Investigation threatened to resign in protest over unconstitutional practices in the National Security Agency’s Terrorist Surveillance Program. Bush backed down but, again, claimed to have been blindsided.

Considering the bitterness that came later from Powell and his subordinates, the most revelatory element of this part of the book is Mann’s reporting that Powell had a change of heart after Bush’s reelection and offered to stay on in his post.

He was rebuffed.

As the book moves into its third and final section, we’re introduced to something that foreshadows some of the problems that President Obama would face in his two terms in office. George W. Bush thought he had earned some political capital by being reelected, but soon discovered that he had no ability to move public opinion or, especially, Congress in his effort to privatize Social Security. Despite embarking on a multistate trip into the heartland to sell his reforms, the bill never even saw a vote.

The failure of the Social Security privatization push was only one blow in what turned out to be a disastrous 2005. Bush’s nomination of Harriet Miers to serve on the Supreme Court was soundly rejected by his own party. The violence in Iraq did not abate despite local elections, and the Democrats, emboldened by an invigorated antiwar movement, began to move sharply against the war. Cheney’s chief of staff, Lewis “Scooter” Libby, was indicted for obstructing justice in the Valerie Plame affair. And then came Hurricane Katrina. According to Mann, even Karl Rove had objected to the appointment of Michael Brown to head the Federal Emergency Management Agency, noting his complete lack of relevant experience.

The year 2006 brought even worse news. The Supreme Court ruled in Hamden v. Rumsfeld that the administration had been violating the Constitution in their treatment of prisoners at Gitmo, necessitating a scramble to set up a military commissions system that never worked. In Iraq, the bombing of a Shiite shrine in Samarra set off a sectarian war, leading Condi Rice to tell Bush, “Mr. President, what we are doing is not working—really not working. It’s failing.” A group of retired generals rose up to demand the ouster of Rumsfeld, who was nonetheless retained. As the midterms loomed, Bush was dragging the Republicans to ruin.

In September, Mitch McConnell, the second-ranking Republican in the Senate, asked to speak to the president in private. Inside the Oval Office, he told Bush that, because of his growing unpopularity, the Republicans were going to lose control of the House and the Senate in the November elections. He pleaded with Bush to start withdrawing some American troops from Iraq. Bush responded that he was not going to let his policy in Iraq be determined by the polls.

McConnell’s predictions came true, of course, ushering in the last phase of Bush’s presidency, in which he would have to contend with a Democratic Congress. Rumsfeld was finally cashiered, and Robert Gates was brought in to right the ship. (When told that Rumsfeld was gone, Condi Rice later said, “I could barely contain my joy.”) Bush defied the election results and ordered a surge of new troops into Iraq in a desperate effort to salvage the disaster there. For Mann, this was the point at which Bush began to become his own man, less reliant on his advisers. The public didn’t perceive the change at the time “because the Iraq War was still ongoing,” but Bush was moving away from Cheney’s influence.

Slowly, things began to get better. But any hope that Bush might have had of salvaging his legacy came to an end when the housing bubble burst in September 2008 and the Great Recession began in earnest. “As September opened, we expected a harsh presidential campaign but an otherwise calm fall,” wrote Laura Bush. Then, between September 7 and September 16, Fannie Mae and Freddie Mac had to be bailed out, Lehman Brothers filed for bankruptcy, Bank of America bought up Merrill Lynch, and the Federal Reserve had to rescue AIG. On September 24, John McCain briefly suspended his campaign. September 29 saw the biggest drop to date in the Dow Jones Index.

Once again, the president had been blindsided.

Mann is careful to note that the financial collapse had seeds in deregulatory efforts that began in the 1970s and were exacerbated by actions taken during the Clinton administration. And he gives Bush credit for dispensing with his ideological predilections during the crisis to enact TARP and save the auto industry. One sign of this break from his natural allies is that Bush didn’t receive a single vote from the Texas delegation on the first TARP vote.

Given the constraints of the format for the book, Mann does a better than adequate job of covering the essential events of Bush’s presidency in a fair way. Inevitably, some things fall through the cracks. There is no mention of the U.S. attorneys scandal, for example, which may have been the most egregious domestic act of national sabotage of Bush’s entire two terms in office. How can one estimate the damage done by the complete politicization of the Department of Justice?

Mann concludes that Bush wasn’t responsible for all the difficulties that America faced both during and after his two terms in office, but he was poorly prepared for the office and self-consciously reckless: “Once, in the midst of a discussion with his military advisers, Bush made a telling observation. ‘Somebody has to be risk-averse in this process, and it better be you, because I’m sure not.’”

It is hard to believe that posterity will be kind to an accidental presidency that owed its existence more to a flawed ballot design in Palm Beach County and a sympathetic Supreme Court majority than to the will of the people. At one point during the first term, a Bush official speaking to the reporter Ron Suskind derided critics in “the reality-based community” and said, “We’re history’s actors … and you, all of you, will be left to just study what we do.”

When we study what they did, we realize that we’re still suffering the consequences.

The post The Reckless Reign of W. appeared first on Washington Monthly.

Boom, Bust, Exodus:
The Rust Belt, the Maquilas,
and a Tale of Two Cities
by Chad Broughton
Oxford University Press, 399 pp.

The only problem? Underneath these top-line indicators, “normal” looks very different today than it did a generation—or even just a decade—ago. Inequality has gone mainstream, with the top 0.1 percent (about 160,000 families) now owning 22 percent of the nation’s wealth (versus 7 percent in the 1970s). More fundamentally, a major pillar of post-World War II American prosperity—well-paid, well-pensioned jobs manufacturing consumer goods for the domestic market—has totally crumbled. While manufacturing employment has been in decline since the late 1970s, the 2000s alone saw a loss of nearly six million jobs, while the aughts became the first decade in sixty years to see zero net job creation.

The remaining factory jobs are largely lower skill, lower paying, and benefits free, while the recovery’s new jobs are centered in the often-precarious service sector. The 2008 housing collapse plunged the middle class’s wealth to its lowest level since 1940, and the economic upswing has been driven not by rising wages but by the highest levels of consumer debt in history.

All this adds up to deeper economic, and cultural, shifts in the American landscape than can be captured by mere statistics. Rising to the task of chronicling this epochal transformation is the University of Chicago public policy lecturer Chad Broughton, with his new book, Boom, Bust, Exodus: The Rust Belt, the Maquilas, and a Tale of Two Cities.

Through rigorous reporting and extensive interviews with workers, Boom, Bust, Exodus tells the stories of two distant but closely intertwined communities: the Rust Belt town of Galesburg, Illinois, and the fast-growing border city of Reynosa, Mexico. For over a century, Galesburg hosted a steadily expanding complex of factories known as “Appliance City,” which employed thousands of workers until it closed in 2004. Meanwhile, Reynosa became the poster child of the maquila industry, in which multinational firms send parts to Mexico to be assembled before being re-imported for final sale in the United States.

Broughton traces the sad trajectory of Galesburg, a small community battered by economic decline. But the story begins with a portrait of a bygone era of plenty—plenty of jobs, plenty of disposable income, and plenty of purchasing power for big-ticket items like the refrigerators produced at Appliance City.

Boom, Bust, Exodus introduces Appliance City in 1959, when it was owned by the Chicago-based Admiral Corporation. At that point, the United States was in the midst of an unprecedented postwar expansion. For much of the 1950s, real GDP growth topped 7 percent and purchasing power spiked by 30 percent. Moreover, growth was equally shared: between 1950 and 1980, income grew just as fast for the bottom of the wealth distribution as it did at the top. By 1974, Galesburg was booming, with more than 10,000 unionized manufacturing jobs in a town of just 36,000 people.

But the good times weren’t to last. A series of corporate maneuvers led to the 1986 acquisition of Appliance City by Maytag, the washing machine producer headquartered in nearby Newton, Iowa. Consolidation within the industry, combined with competition from domestic giants like General Electric and foreign companies like Haier, resulted in a total focus on cost cutting that strained union-management relations. “Instead of going into negotiations asking, ‘How much are we going to get,’” says one of Broughton’s union interviewees, it was “How much are we going to have to give up?” By 2002, the local union was pushed to the brink of strike; just months later, Maytag announced that the Galesburg plant would close—with operations reopening in Mexico at the Planta Maytag III in Reynosa.

Thirteen hundred miles to the south of Galesburg, history was moving in the other direction. While middle America deindustrialized, Mexico was traveling the same difficult road toward industrialization that developed countries had taken more than a century before. Progress, as in Dickensian London or early-twentieth-century New York City, took the form of low-wage factories filled with desperate migrants packed into precarious and chaotic urban slums. And in Reynosa, the central figure—the villain or visionary, depending on whom you ask—was Mike Allen, the charismatic leader of the McAllen Economic Development Corporation, or MEDC.

From 1987 until Allen’s retirement in 2006, the MEDC was the driving force behind positioning Reynosa, and its neighbor McAllen, Texas, at the bleeding edge of globalization. The MEDC lobbied officials, pressured labor leaders, and stoked infrastructure development in order to position the Reynosa-McAllen “node” as the leading option for multinationals seeking an edge. As Broughton writes, “The MEDC worked daily with companies from twenty-five countries to give them everything they wanted: a cheap and flexible labor force, a fluid border, low transaction costs, efficient logistics, and access to the largest consumer market in the world.” Allen also pushed hard for the North American Free Trade Agreement (NAFTA), which the Galesburg workers, like so many other American workers, blamed for their woes.

But if anything, Broughton’s narrative underscores how these downward trends predated NAFTA, which only began taking effect in 1994. Appliance City, like much other American manufacturing, was under pressure from firms in Asia and Europe well before the maquila industry took flight. And the Congressional Budget Office, among others, has concluded that NAFTA barely moved the needle on total U.S.-Mexico trade—something NAFTA’s boosters would also do well to keep in mind.

Where NAFTA likely had a much greater impact—and where Broughton focuses much of his attention—is its role in hastening the collapse of Mexico’s small-scale farming (ejido) economy. With protective import tariffs gone, highly subsidized American grain flooded the Mexican market, sweeping away all but the largest and most export-oriented agribusinesses. For many of these now-unemployed rural laborers, the booming maquila factories became their only hope for a livelihood.

In the view of Mexico’s intelligentsia, this restructuring of the country’s inefficient farming sector was inevitable. That may well be true. Throughout Boom, Bust, Exodus, critics of the haphazard industrialization in Reynosa are asked whether, given a simple yes-or-no choice, things are better with the new factories. It’s a loaded question, but most reluctantly answer in the affirmative.

One Planta Maytag III worker whom Broughton follows over the course of several years clearly illustrates this ambivalence. Laura Flora Oliveros found factory life harsh and unforgiving after her upbringing in rural Veracruz. But she continued to choose the low wages, long hours, and chaotic urban life because of the promise of steady work, overtime pay, and upward mobility for her children. “The only inheritance that I can give you is your education,” Flora tells her daughter.

Thus, despite Broughton’s nostalgia for the heyday of the American union, and the author’s penchant for indulging in anti-globalization sloganeering, the lessons in its pages are essentially realistic ones. Back in Galesburg, there are few illusions about the return of a 1950s-style economy. The book’s most instructive—and moving— moments involve the daily struggles of former Appliance City workers to move on and remake their lives. One shrewdly acquires a degree in the growing field of radiology. Another pursues her dream of a journalism career, working and attending school as a single mother. Yet another struggles with crippling factory-work-related injuries and sinks into alcohol dependency. Most of them are scraping by on severely diminished incomes, unfulfilled pensions, reduced hours, and unstable benefits. Many find that their lack of formal education renders them desperately unequipped for the job market. For all of them, who were once part of the upwardly mobile middle class, supports such as Trade Adjustment Assistance, unemployment benefits, and food stamps have been critical for survival.

Given the anger and disillusionment that drives much of his narrative, Broughton offers a surprisingly moderate conclusion. “Economic globalization is not the nub of the problem,” he concedes. “It’s how the American political system responded (and failed to respond) to it.” What would a better response look like, then? He has several options in mind—from narrow measures like more generous worker retraining to broader reforms in education, health insurance, and a more robust national industrial policy. None of these policies, however, would overturn globalization or the changes it has wrought; they would only mitigate its impact on those hardest hit.

Ultimately, Boom, Bust, Exodus serves as a reminder that there was nothing inevitable about America’s period of plenty, and no guarantee that it will return anytime soon. More sobering yet is the thought that perhaps it was that unprecedented prosperity, and not our subsequent malaise, that was the historical anomaly. “Even economies have histories,” wrote the late scholar Tony Judt. Chad Broughton has done us a service by shedding a bit more light on the one in which we are currently living.

The post The Future of Work appeared first on Washington Monthly.

The cost of health care is now so high that even historically low percentage increases in medical inflation do serious damage to the economy and household budgets. The total annual cost of health care for a typical family of four covered by a typical employer-sponsored plan reached $22,030 in 2013, or roughly the equivalent cost of buying a brand-new Honda Accord LX every year. That was bad enough, but last year, with the base cost so high, a “mere” 5.4 percent increase in health care costs sucked an additional $1,000 out of such a family’s standard of living.

The continually growing burden of health care costs is a major reason why employers are so reluctant to hire and wages remain stagnant. At the same time, even patients with employer-provided plans are paying an ever higher share of the cost of their care (42 percent in 2014) directly out of their own pocket. What moderation we’ve seen in the rate of increase in health care spending comes not from increases in health care efficiency or decreases in health care prices but from a tough economy combined with the spread of high-deductible health care plans, including those offered on the exchanges under Obamacare, which cause people to forego care they may well need.

America’s Bitter Pill:
Money, Politics, Back-Room
Deals, and the Fight to Fix
Our Broken Healthcare System
by Steven Brill
Random House, 512 pp.

Meanwhile, because of our failure to roll back inflated health care prices, a higher percentage of Americans are uninsured today than in 2001. And despite a massive increase in Medicaid spending and insurance premium subsidies offered under Obamacare, a recent Commonwealth Fund survey finds that a higher share of Americans (35 percent) now report difficulties in paying medical bills or have medical debt than in 2005.

Two years ago, Steven Brill published an extraordinary, 24,000-word cover story in Time magazine that took on these issues, concentrating on the profit-maximizing practices of America’s so-called “nonprofit” hospitals. Wonky yet filled with compelling human interest anecdotes, the special report offered hope, to me and many others, for the future of both serious journalism and health care reform. Brill and Time appropriately received the National Magazine Award for public interest journalism.

Now comes the inevitable book, based on the original story plus four others that Brill subsequently published in Time. Unfortunately, though America’s Bitter Pill contains important information about how the political economy of health care actually works and in the end comes to strong, if not original, policy prescriptions, it’s poorly argued and a pretty dreadful reading experience. You’d be well advised to let someone else distill the key take-aways.

The first 200 pages cover the battles that led to the passage of the ACA. Then come another 200-some pages in which Brill mostly tries to reconstruct what went wrong with the rollout of Obamacare, concentrating on the star-crossed HealthCare.gov website.

Both sections suffer from a defect that should have been a virtue. Brill, to his credit, has done a lot of old-fashioned, face-time reporting. In his acknowledgments, he writes that he interviewed “243 people—many of them multiple times—over twenty-seven months.” This is a refreshing contrast to the increasingly standard journalistic practice—driven by a combination of vanishing media resources and sometimes arrogance—in which reporting mostly amounts to shooting off “smart takes” based on Google searches and Twitter feeds.

But Brill’s old-school style of reporting has always been vulnerable to certain deficiencies, and they show up here as he attempts to build his previous work into a higher, more comprehensive synthesis. One is a tendency to, in effect, just cut and paste quotes and anecdotes from one’s many interviews and call it an analysis. Sometimes, to be sure, this can result in the reader coming across random gems. I enjoyed Brill’s account of how the crisis team that was sent in at the last moment to fix the broken HealthCare.gov website conducted all its meetings standing up and under a sign that read, “The war room and meetings are for solving problems. There are plenty of other venues where people devote their creative energies to shifting blame.”

That’s a keeper. But I had to force myself to not skim during hour upon hour of reading through seemingly pointless other details about each small twist and turn in the troubled project. The only systematic lesson Brill draws from the website debacle is that the Obama administration, fearful of creating a human target for Republicans in Congress, failed to put anyone in charge of the project at a high enough level.

Another feature of Brill’s reporting style is that he always seems to wind up thinking the best of his sources once he’s spent a lot of time with them. Here, for instance, is a sample of his treatment of former Democratic Senator Max Baucus and the senator’s former aide, Elizabeth Fowler. “At first impression,” Brill writes, “Baucus’s genial demeanor, punctuated by a habit of bursting into a grin even after he hears or says something serious, often makes him seem less intelligent or substance-oriented than he is. Yet, Fowler recalled, ‘Max was really serious about healthcare. He wants to do something big and thought this was the time.’ ”

Both Baucus and Fowler were vilified in progressive circles for their role in accommodating the demands of Big Pharma and other corporate interests during the fight over the ACA. But rather than seriously weigh the merits of such criticism, Brill just wants you to know that Baucus and Fowler are good people. For readers in the know, this can lead to head-slapping moments, as when Brill bemoans how foundational provisions that would have led to meaningful federal research into the comparative effectiveness of different medical treatments were ultimately gutted from the act. He has apparently never put it together that Baucus played a key role in stripping those provisions from the bill, acting in concert with Big Pharma and its Republican allies (see my take on the subject in “The Republican Case for Waste in Health Care,” Washington Monthly, March/April 2013).

Brill’s tendency to think highly of his sources is also in evidence when they turn out to be his own doctors. Early on in the book, Brill strikes a strange note when he lets us know that his thinking about health care costs has been changed by his experience as a patient at New York-Presbyterian Hospital in Manhattan. Brill tells us that while he was at work on the book, doctors there diagnosed him with an “aortic aneurysm” and then split open his chest with a high-power sternum saw in an operation that he believes saved his life. As a result of this experience, he writes, “I now understand, first hand, the meaning of what the caregivers who work in the system do every day. They do achieve amazing things and when it’s your life for your child’s life or your mother’s life on the receiving end of those amazing things, there’s no such thing as a runaway cost.”

When I read this, I identified with Brill’s emotion, but a big red flag immediately started waving in my head. Did Brill know where he was? Some aortic aneurysms are indeed life threatening, and it may well be that he truly needed this operation. He may also have received excellent medical care that was worth every penny. But as Brill could have confirmed with a few keystrokes, Medicare data maintained by the Dartmouth Atlas of Health Care shows that New York-Presbyterian scores vary high on various measures of over treatment.

For example, the hospital ranks 66 percent above the national average on Dartmouth’s “intensity of care” index, which compares hospitals by looking at how many different doctors become involved in a patient’s care during his or her last two years of life, and by counting how many days equally sick patients remain hospitalized. When a hospital scores high on this index, it is a strong indication that its patients receive far more intensive and expensive treatment than do equally sick patients at other hospitals, but with no better results. New York-Presbyterian also ranks worse than average in the number of complications resulting from surgery, as Consumer Reports and Time magazine itself have reported.

The prevalence of hospitals like New York-Presbyterian that engage in anomalously high intensities of care is a big deal in the world of health care quality research. Their existence suggests that as much as a third of all health care spending in the U.S. goes for treatment that is unnecessary and often harmful. Indeed, this finding was often repeated by the architects of Obamacare, who used it to explain how they could, at least theoretically, expand coverage while simultaneously “bending the cost curve.”

Yet Brill, in his dual role of patient and health care analyst, seems bizarrely obtuse to the reality and importance of overtreatment. He complains that New York-Presbyterian presented him and his insurance company with bills that were inscrutable, and that they totaled $197,000 for eight days in the hospital. He shrewdly reports that New York-Presbyterian has achieved such market concentration in Manhattan that no insurance company has the power to bargain down its high prices.

But it does not seem to have occurred to him that he may not have needed an operation in the first place, or that even if he did, many of his fellow patients may have been victims of overly intensive care. All serious students of the American health care delivery system agree that high volumes of unnecessary surgeries, overprescribing, and redundant testing are major features of the hydra-headed beast that confronts us. Yet Brill, while he sometimes makes passing references to doctors ordering unneeded tests, and criticizes the ACA for not putting an end to fee-for-service medicine, repeatedly goes out of his way to excuse his and most other doctors from culpability in the health care crisis.

“Most do not ride the healthcare gravy train the way hospital administrators, drug company bosses, and imaging equipment salesman do,” he writes. That may be true, but it’s not saying much. A fifth of all health care spending goes directly to doctors, which is double the share that goes to drug companies and many times more than the share that goes to the medical device industry, let alone hospital administrators. And while most primary care docs are overworked and underpaid, most specialists enjoy fast-rising incomes that are far above those of their counterparts in other advanced nations. The incomes of U.S. dermatologists, gastroenterologists, and oncologists, for example, rose 50 percent or more between 1995 and 2012 even after adjusting for inflation. The average dermatologist made $471,555 in 2012, according to the Medical Group Management Association.

What Brill gets most importantly right about the political economy of health care is the role that provider cartels and monopolies increasingly play in driving up prices. He provides excellent on-the-ground reporting, for example, on how the University of Pittsburgh Medical Center has emerged as a “super monopoly” dominating the health care market of all of western Pennsylvania—first by buying up rival hospitals or luring away their most profitable doctors, and now by vertically integrating to become a dominating health insurance company as well.

Brill similarly reports how the Yale-New Haven Hospital gobbled up its last remaining local competitor in 2012 to become a multibillion-dollar colossus. Importantly, Brill shows readers how, after the merger, an insurer could not “negotiate discounts with Yale-New Haven,” because “it could not possibly sell insurance to area residents without including the only available hospital in its network and the increasing share of the area’s doctors whose practices were also being bought up by the hospital.”

This dynamic is playing out in virtually every medical market across the country, as hospitals buy up one another and the local health care infrastructure, such as labs, clinics, and individual doctor practices, to secure monopoly rents. According to Brill, at least some White House insiders (he names Zeke Emanuel) saw the trend coming and tried to insert language into the ACA that would have done something to contain it. But their efforts were rebuffed, says Brill, when regulators at the Department of Justice and the Federal Trade Commission stated that “this was a complicated problem that needed lots of further study before anything might be done.” Brill reports his sources as telling him that there was another problem as well: “meddling with antitrust laws would require the involvement and approval of the Senate Judiciary Committee and its turf-conscious chairman, Patrick Leahy of Vermont.”

The final 100 pages or so are largely taken up with a Q&A section in which Brill, somewhat bizarrely, interviews himself about what it all means, and then lapses into a rambling discussion of various policy options. The most prominent of these is one that, I have to say, I strongly agree with. Brill describes a breakthrough moment when it came to him that large, integrated health care providers such as the University of Pittsburgh Medical Center may actually have the potential to hold down prices by taking advantage of their size to deliver less fragmented, more evidence-based, integrated care. But this will only happen, he realizes, if rigorous antitrust enforcement ensures that they are subject to at least some meaningful market competition, and if government regulation forbids them from engaging in abusive price discrimination and profiteering—policy prescriptions we laid out over a year ago in these pages (“After Obamacare,” January/February 2014).

In short, Brill accepts that twenty-first-century health care systems need to become big and integrated to improve their efficiency, but wants them to be treated just “the way a public utility is—with still tighter controls on profits.” It’s a brilliant suggestion, and proof that great minds think alike.

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Over the past four decades, large corporations have learned to play the Washington game. Companies now devote massive resources to politics, and their large-scale involvement increasingly redirects and constricts the capacities of the political system. The consequence is a democracy that is increasingly unable to tackle large-scale problems, and a political economy that too often rewards lobbying over innovation.

Much public opinion on the subject of political influence suffers from a confusing and counterproductive mix of hopeless idealism and fatalistic cynicism. On the one hand, many people think that if only we could get special interests out of politics, then we would have a government run by perfectly rational Solomonic lawmakers, capable of divining the true public interest and making wise and uncorrupted judgments. On the other hand, they look at the political system and think that most politicians are at once craven and venal, ready to sell their votes for the promise of a hosted fund-raiser or, even more cheaply, a few thousand dollars in PAC contributions.

The reality is, of course, more complicated, but it’s also much more interesting. Like everyone else, politicians are motivated by a mix of both noble and not-so-noble intentions. There are good politicians and not-so-good ones, but any attempt to cut them off from societal pressure is a betrayal of both the idea of representative democracy and the potential for the collective intelligence that widespread participation in the political process allows for. The Washington lobbying community is full of many bright policy minds, and the expertise and knowledge that the business community can provide makes for a more informed policymaking process.

Any attempt to directly limit the participation of corporate lobbyists in the political process runs immediately into the practical problem that efforts to limit political influence have always encountered. If corporations (and other actors) are determined to influence the political process, they will find a way. If the history of political influence regulation has taught us anything, it should be this: those determined to participate in the political process will find ways to do so.

There are, however, three genuine problems that do need fixing, and that can be fixed in ways that work with, not against, the realities of politics.

The first problem is the balance of power. When corporate interests spend $34 for every $1 diffuse interests and unions combined spend on lobbying, it is not a fair fight. If we want a political system that is capable of responding to broad societal interests, we want a political system in which a broad range of societal interests are capable of presenting their most effective case. When large corporations are the dominant actors in Washington, policy attention will almost certainly reflect their priorities.

Take drug companies. In 2004, the industry won the passage of Project BioShield, which allocated $5.6 billion in federal funding to stockpile drugs to combat a potential bioterrorism attack. Yet, even after the bill was passed, drug companies were not entirely satisfied; they wanted protection from loss in developing bioterrorism vaccines. It was a telling sign of just how emboldened the industry had become.

The second problem is the asymmetry of information and the related complexity. When government actors are forced to rely on outside lobbyists for policy expertise, and when that expertise is provided largely on behalf of a narrow set of actors, this is likely to distort outcomes.

Additionally, policy complexity makes it easier for the corporate actors with the most resources to make quiet changes with little to no scrutiny. Tax policy is a good example of this influence. As the authors of a 2005 presidential advisory panel report on tax reform noted about the 15,000 changes to the tax code between 1987 and 2005,

Each one of these changes had a sponsor, and each had a rationale to defend it. Each one was passed by Congress and signed into law. Some of us saw this firsthand, having served in the U.S. Congress for a combined 71 years, including 36 years on the tax-writing committees. Others saw the changes from different
perspectives—teaching, interpreting, and even administering the tax code.

Almost all of these were small provisions in larger bills. Few received anything close to public scrutiny. As the report acknowledged, this approach has had negative consequences: “In retrospect, it is clear that frequent changes to the tax code, no matter how well-intentioned, ultimately undermine the integrity of the code in real and significant ways.” The tax code is now almost four million words long.

The third problem is particularism. Companies are increasingly oriented toward narrow, rent-seeking outcomes. Parochial intra- and inter-industry battles take up an increasing amount of Washington bandwidth, and the growing investments in particularism crowd out the capacity of the political system to address larger problems. University of North Carolina at Charlotte professor Ken Godwin and colleagues have argued that corporate lobbying can be modeled as a two-stage game. First, companies join together in order to get an issue onto the agenda, aware that it often takes a large coalition to break the threshold of attention. Then, once the issue gets serious consideration, companies break off and advocate for themselves.

What may be good for some powerful companies is almost certainly bad for the economy as a whole. One chemical company’s lobbyist summarized the process: “In the beginning most of us cooperate to get Congress’s ear, but in subcommittee it’s every man for himself.” Another lobbyist provided a similar perspective on lobbying the bureaucracy: “When EPA is considering a new rule, we [the firms in her industry] stick together. In the end though, I need to have the final rule written for [her firm], not for [her firm’s major competitor].”

These problems are all related, and any attempt to deal with one without dealing with the others is likely to fail. Sticking with the rule of threes, I propose three types of solutions. As with the problems, the solutions are interrelated. They would be most effective as a coherent program. Piecemeal application would almost certainly be far less successful.

Solution #1:
Let Everyone Have a Lobbyist

I take very seriously James Madison’s argument in Federalist No. 10 that the problem of factions is inherent to all political systems, and that any attempt to limit the faction participation is a cure worse than the disease. I share his faith that the best way to deal with the problem is for faction to counteract faction and to, in his term, “enlarge the sphere.” Let everyone have their say, and hope that something resembling the public interest emerges from the dust.

Of course, this approach depends on a rough balance of power. If unions and diffuse interest groups had roughly the same resources as business interests, we might reasonably expect that the two forces would keep each other roughly in check. This, however, is not the case. As we’ve seen, corporate interests now spend thirty-four times what diffuse interest groups and unions combined spend on lobbying. Not a single corporate lobbyist I interviewed for my book The Business of America Is Lobbying identified a diffuse interest group or a union as the primary opponent on an issue on which he or she was lobbying. Faction is not, in fact, now counteracting faction.

This is not likely to change on its own, for two reasons. One is the simple fact that it is relatively easy for businesses to mobilize politically since they can, with just a few executive decisions, allocate some of their already-existing resources to political activity. And now that a growing number of business leaders have become convinced that politics matters, there is very little to stop them from continuing to spend substantial sums. Interested citizens, by contrast, must find a way to overcome the collective action problem, pulling together resources and commitments, and then sustaining those resources and commitments over time. This is difficult to accomplish.

Secondly, the nature of much political conflict, in which a particular policy affects a handful of companies greatly while affecting most citizens only marginally, means that individual companies and industries have the most concentrated stakes, and therefore the biggest incentive to remain vigilant and active. Businesses have both the means and the motive to spend heavily. Both their stake in political outcomes and their ability to mobilize resources are far greater than the average citizen. Fixing the participatory imbalance will require government to make an active investment. There is clearly a market failure.

Is there a public interest in fixing this imbalance? One analogy is to our legal system. Indigent criminal defendants are given court-appointed lawyers because we have decided that everyone should have the right to a lawyer when they interact with the justice system. Why does the same principle not apply to politics? Doesn’t everyone whose interests are materially affected by the political system deserve the right to a lobbyist?

Certainly, there are difficulties in determining who has a legitimate claim for lobbying representation, and how much representation they deserve. But here’s one way it could work: Groups advocating for a diffuse interest would have to demonstrate that their perspective was shared by a threshold percentage of citizens, and that the existing lobbying community was not adequately representing this viewpoint. Imagine a three-stage process. First, an underrepresented perspective would have to gain a certain number of signatures (perhaps 25,000) and advocates of the perspective would need to demonstrate that they were being outspent by at least a threshold ratio (perhaps 4 to 1), and that a diffuse group of citizens were affected. Then, that perspective could be included in a regularly occurring poll that the government conducted to test for widespread support in the country. If a threshold percentage of citizens (perhaps 25 percent) agreed with the perspective, a federal subsidy would be awarded so advocates of that position could hire a lobbyist. Subsidies could be awarded based on the level of support and the ratio by which advocates for that position were being outspent by powerful interests. A more aggressive version of this proposal would require well-funded interests on the other side to fund their opposition, in order to guarantee a fair fight.

Alternately, rather than award a direct subsidy to the underrepresented perspective, the federal government could create an Office of Public Lobbying, maintaining a team of public lobbyists who would then represent different public interest clients before the government. Zephyr Teachout has made the case for such an institution, noting that “Congress could hire, at a fraction of the expense paid to lobbyists, advocates to represent a range of opinions on any proposed legislation, and stage trial-like debates between them.” Serving as a public lobbyist might be a very appealing job for a congressional staffer whose boss lost an election or retired, or a congressional staffer just looking to do something different for a few years. Many congressional staffers may not necessarily desire to represent corporate interests, but they want to stay in Washington and remain active in public policy. Working as a public lobbyist could provide an appealing alternative to a K Street job, while giving a voice to a set of societal interests that currently lack a voice in Washington. It might also provide an alternative to working for a nonprofit because it would provide more variety and job security. Additionally, an Office of Public Lobbying could actively work to identify underrepresented voices, utilizing social media and other low-cost methods to tap into diffuse public concerns and give them a voice.

Solution #2:
Let Everyone In On the Lobbyists’ Secrets

In 1946, Congress passed the Administrative Procedure Act, which created “uniform procedures for rulemaking, adjudication, and transparency on federal agencies.” Now most executive-branch agencies have a structured rulemaking process. Before a rule can be finalized, all interested parties have a chance to comment. Those comments are public, and agencies respond to those comments in a public way. While there is certainly additional lobbying that takes place beyond formal commenting, the comments provide a useful way to see who is participating and whose concerns are being heard. All agencies post these comments online.

Lobbying Congress, by contrast, remains as haphazard as it has ever been. While organizations do have to file quarterly lobbying disclosure reports, these reports are vague. They may list specific issues, or they may not. Organizations lobbying do not have to disclose which offices they visited, nor do they have to disclose the positions for which they advocated or the draft legislation they left behind.

What if Congress passed a Congressional Lobbying Procedure Act that created a set of uniform processes for congressional lobbying? Such a system could take advantage of modern technology and require that any advocacy be posted within forty-eight hours on a central website. Each report would contain a short summary of the meeting, who attended, and what was advocated for.

Any white papers, draft legislation, or other leave-behinds would need to be posted in electronic form as well. The website would also serve as a repository for all arguments and advocacy. A series of clicks would take any interested member of the public to a corpus of arguments for or against particular public policies, creating a central clearinghouse.

Such a website could also make it much easier for citizens to offer input and register their opinions in an organized and traceable way (as opposed to the current sporadic and haphazard barrage of emails and phone calls, which may or may not get a response). Organizations like the Madison Project and POPVOX have done impressive work exploring how the Internet could provide a forum for wider citizen participation in the legislative process, and both offer valuable frameworks for going forward.

This hypothetical Congressional Lobbying Procedure Act would change lobbying in several ways. First, it would level the playing field between corporate interests and diffuse interests. It would make lobbying less about hiring armies of well-connected lobbyists who can spread out all over Capitol Hill and more about developing convincing arguments and summaries that would inform congressional offices.

It would also become easier for diffuse interests to know what corporate interests are actually arguing, which would allow them to respond to those arguments in a timely matter (and vice versa). Ultimately, this website could serve as a kind of policymaking marketplace of ideas, where different interests would have the opportunity to respond to each other in real time. It could harness the competitive nature of lobbying in service of accountability, would provide an instant source for all arguments on all sides, and would help congressional staffers new to an issue to know where they could find more information.

Such a process could also potentially reduce particularistic lobbying efforts. By bringing real-time transparency to attempts to insert narrow provisions into legislation, this system could alert watchdogs as these attempts happened, allowing them to blow the whistle and bring public scrutiny to deals that largely depend on nobody else paying attention to them. This could make members of Congress more wary of working to advocate particularistic benefits. In turn, lobbyists would be able to anticipate the consequences of such narrow asks. They would know that the risks would be high and the likelihood of success low. This would make them much less likely to make such asks in the first place. This could also have the effect of reducing lobbying, especially particularistic lobbying. This is, admittedly, optimistic, but it at least points in the right direction.

If lobbyists were able to put fewer particularistic policies in place, it would be harder for them to demonstrate to their corporate bosses the bottom-line benefits of lobbying. It would reduce the number of purely selective benefits in corporate lobbying. As lobbying moved more toward collective benefits, fewer companies would want to foot large bills to lobby. An added benefit of lobbying becoming less particularistic is that legislation could become simpler. There would be less need to address the narrow concerns of every single company with a lobbyist. It would be easier to move toward more coherent policymaking.

Such a system could also alter the information asymmetry between lobbyists and corporate managers. I’ve argued that one of the key reasons why corporations spend more on lobbying is because managers do not get to observe what lobbyists do and how their actions do or do not move the policy needle. Lobbyists can claim that they had substantive meetings with members of Congress and overstate their influence. If corporate lobbyists had to document everything that they do to try to influence political outcomes, managers would be in a better position to evaluate their lobbyists’ activities. Doing so might allow savvy corporate managers to conclude that most of what they spend on lobbying is, in fact, wasted. They might spend less on lobbying. In principal-agent literature in economics, transparency is commonly seen as a way for principals to overcome information asymmetries and thus reduce their costs.

Solution #3:
Let Lawmakers Have Enough Expert Staff So That They Don’t Need Lobbyists

A third approach would give Congress more of its own policy capacity. As I have argued, one of the reasons why lobbyists have become increasingly central to the policy process is that the policy capacity of the government, and especially Congress, has declined over time while policy complexity and specialization have increased. Congressional staffers are always scrambling to play intellectual catch-up. They have to turn to lobbyists to explain increasingly complex policy to them. This gives lobbyists a tremendous advantage.

There are a number of potential ways to reduce congressional dependence on lobbyists. One is simply to improve the working conditions and salaries of congressional staff, making it a more attractive job for senior-level people. Rather than toil in anonymity at relatively low pay with long, unpredictable hours, congressional staffers should be given more acknowledgment, better pay, and more favorable working conditions. If congressional offices paid staff better, they could afford to attract and retain more top policy talent, and make it less likely that congressional staff would use their time on the Hill to plot their exit, potentially cozying up to lobbyists who might someday make them rich.

In most congressional offices, working conditions could be improved dramatically. Hours could be better, and staffers could be allowed to take more credit and ownership for the work that they produce. Members of Congress could acknowledge that while they set the general direction and priorities for the office, an entire team of people represents the constituents of each district, and all members of the team deserve public credit. While the private sector is likely to continue to be able to pay people more, elected officials ought to acknowledge that who they hire has an enormous impact on how well they can serve their constituents, and be willing to invest in good people. (Some of this may seem like Management 101—but Congress could use a heavy dose of Management 101.)

Congress could also improve its independent policy capacity externally. Already, Congress has institutions designed to help it. The Congressional Research Service (CRS) and the Government Accountability Office (GAO) are both valuable resources, and they play an important role in providing independent expert advice and research. But both are severely underfunded and understaffed. The most straightforward approach to improving congressional capacity may be simply to significantly expand the budgets and institutional reach of these two agencies.

Another possibility would be to tap into the knowledge and expertise that resides in American universities. House and Senate offices could officially partner with local universities, particularly public policy schools and law schools. Professors could serve as expert advisers. Universities could incentivize participation by giving formal credit to faculty who lend their expertise and lead students to help make national policy. Students could get excellent training serving as policy researchers and legislation drafters for congressional offices. Shouldn’t helping to improve the quality of public policy for the country be at least on par with publishing academic articles in small peer-reviewed journals? One approach in this direction comes from the Congressional Clerkship Coalition. More than 100 law school deans have urged Congress to create a “congressional clerkship” program that would be a legislative analog to the judicial clerkship program, giving young lawyers more legislative experience and congressional offices more legal help. But while legislation to create the program has passed the House twice and enjoys widespread bipartisan support, it has not made it out of the Senate.

Heather Gerken and Alex Tausanovitch have suggested funding “policy research consultants” who would be available to congressional offices:

What we have in mind is the lobbyist equivalent of public-interest law firms. The aim would be to allow legislators to hire “research consultants” who can provide information during the major stages of decision-making as well as during the period in which the bill is amended. These independent consultants would have a semi-permanent status, and thus able to offer the “long-term commitment” that bears fruit in the lobbying world. They would be able to assist members with thinking through issues before they even get on the agenda of a particular committee, and they would be able to put their time and effort into developing good policies over the long-term.

Congressional offices would be able to choose whomever they wanted as their consultants. They could, for example, choose lobbyists from the oil industry, but as Gerken and Tausanovitch argue, they would have no reason to do so, since they already get plenty of policy support from the industry, which happily provides it for free. Rather, these research consultants would allow them to get the legislative subsidies that they couldn’t get elsewhere.

Though executive branch agencies tend to have better salaries and working conditions and are able to attract more policy expertise, even they are increasingly having a hard time maintaining the levels of internal expertise necessary to make policy in complex environments. They also suffer similar pay gaps and could benefit from more policy resources.

The basic thread of all these capacity-building reforms, however, is the same: in order to make the best policy, government needs the best people, and a lot of them. If key policymakers don’t have the resources to adequately evaluate policy and have confidence in their observations, they will be forced to rely excessively on those interests who have the most at stake.

How These Solutions Would Work Together

Perhaps the best way to understand how these reforms work together is to see how they solve the possible objections that could arise from applying the reforms piecemeal. The most obvious objection to the Madisonian approach of enlarging the sphere is that Washington lobbying is already exceedingly competitive, and this competition is a source of gridlock. Wouldn’t more competitive lobbying mean even more gridlock? This is a legitimate concern, especially if it means that congressional offices became even more overwhelmed by an onslaught of lobbying than they already have been. But moving lobbying into an online public conversation and giving offices more of their own policy capacity would help to better channel the lobbying activity. Rather than being overwhelmed by all the arguments and advocacy, congressional offices would have the expertise and knowledge to sort through the information and pressures more productively. Moreover, the capacity of an online platform to organize the information would help staffers, who often lack the time to stay organized. It would remind them of the bigger picture, rather than just the concerns of whomever they met with last.

The limitation of real-time online lobbying is that the corporate interests with the most resources could simply overwhelm this process, like they overwhelm every other process. They could invest more resources in shaping the intellectual environment and more resources in responding to the opposing concerns. While the platform would have some leveling effects, they would not be nearly enough. In the absence of other reforms, this would almost certainly be the case. But if the government could take active steps to level the playing field by subsidizing diffuse interests, this would be less of a problem. If lawmakers had more capacity to evaluate the information without the help of lobbyists, this would also be less of a problem.

Even with expanded government policy capacity, government actors would still need the help of outside interests. They might need less help, but they would still require some assistance to develop, vet, and, especially, build external support for policy initiatives. After all, the “legislative subsidy” that lobbyists provide isn’t only about policy expertise. It also covers the entire policy process. Without making some attempts to level the imbalance of lobbying resources, it would still be difficult for congressional offices to advance causes that lacked organized lobbying resources. Government intervention to balance the playing field could help. Moving lobbying online and creating a repository of policy arguments could also help, because it would give congressional offices more resources on which to draw.

Another critique of this build-more-capacity approach is that expertise is never neutral, and just because members of Congress had access to more policy capacity wouldn’t necessarily mean that they wouldn’t simply use it in service of whatever narrow ends they might already be working toward, and to pick and choose studies that supported their existing beliefs. This is certainly a fair critique. Dreams of a perfectly rational, scientifically minded technocracy never end well, but all else being equal, more expertise and more policy capacity are almost certainly better than less. Certainly, there would be members of Congress who would be unaffected, but ideally this approach would push policymaking in a smarter direction. It would provide policymakers with the resources to stand up to industry “experts” whom they might have reason to doubt but lack the topic knowledge to confront.

In short, this package of reform works best as a coherent program. One strength of this program, as compared to many other reform programs, is that it embraces politics, rather than attempting to sublimate it. It is built on the premise that more lobbying and more political engagement is better, and more money and more resources (rather than fewer) ought to go into shaping public policy, and argues that it is possible to channel political competition in a constructive way. It also does not treat members of Congress as venal, corrupt individuals who are incapable of standing up to moneyed interests. It acknowledges that they would like to serve a broader public interest, and could do so more effectively if they had some additional help.

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