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Alan Chao's avatar

For all the shit he catches from “the left,” nobody describes the concrete materialist stakes like MattY.

Also, for all the squabbling post election, it’s crystallizing to see who the enemy is - The GOP exists really, to do this, to cut income and capital gains taxes for high earners and reduce wealth distribution. If you think that’s bad, the guns point that way.

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Ben Krauss's avatar

This was hinted at in last week's piece on the vibe shift. But I think a huge portion of my age demographic has very little memory or understanding that this is still the biggest game in Washington.

I don't want to discount the genuinely norm breaking and bad parts of Trump's presidency (there's a lot we don't know yet). But the most discernable GOP north star has been, and will continue to just be cutting back the welfare state. And if that happens, I might just attend a protest outside the White House!

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Charles Ryder's avatar

I'm more worried about the international arena and the general degradation of the effectiveness of the federal government. Trump and the GOP can and will do some damage with respect to domestic programs and the tax code, yes, but there are serious limits given their reliance on EOs and reconciliation.* And one day Democrats will have a trifecta again.

But Trump is just so unrestrained when it comes to trade and foreign policy. He could effectively end NATO with a single sentence. He could (and very likely will) eviscerate international economic norms. He could (and very likely will) drive qualified professionals away from government service for the rest of their careers, thereby reducing its capacity to do good for many years.

And I fear the US is suffering damage to its reputation that will take years to undo, maybe decades. After all, the next time a Democratic President wants to strike an agreement with another government, the latter will inevitably think: how long is it until the "Gulf of America" party is back in power?

*I assume the experts who say birthright citizenship is safe know what they're talking about. If not, then all bets truly are off.

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Auros's avatar

Yeah, as Krugman has said, the experience of Trump is going to chill investment in friend-shored supply chains, and make our allies question whether they can rely on the US. We've spent eighty years in the position of a trusted broker of international conflicts -- even our enemies believed they could generally trust us to meet commitments in ratified treaties. Now they'll have to question whether the electorate is going to put some nut into power who will just do random stuff in violation of our agreements, and dare the courts to stop him.

https://paulkrugman.substack.com/p/how-to-damage-us-manufacturing

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David_in_Chicago's avatar

Thanks for posting this. Will read through it on the plane tomorrow. But in general, I feel like Krugman has a huge blind spot for US manufacturing. Noah Smith too - but that's a separate issue. I've posted this link before but the Hyundai new CEO just straight up said they're increasing their US manufacturing investment as the "best antidote to Trump tariffs". The BMW CEO just publicly pressured the EU to lower US import tariffs from 10% currently to 2.5%. There's at least enough of these big, public CEO statements that IDK ... you can see how foreign investment could flow back in.

https://www.axios.com/2025/01/15/hyundai-trump-tariffs

https://www.reuters.com/business/autos-transportation/bmw-ceo-proposes-cutting-eu-tariff-us-vehicle-imports-25-2025-01-28/

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Auros's avatar

There were also lots of noises about reversing off-shoring in Trump's first term, which didn't amount to much.

https://www.wfyi.org/news/articles/four-years-later-trump-carrier-deal-doesnt-slow-offshoring-as-some-had-hoped

https://www.reuters.com/business/foxconn-sharply-scales-back-wisconsin-investment-2021-04-20/

Biden then comes along with much more narrowly targeted tariffs, and bipartisan passage of CHIPS and BIL and IRA, and suddenly we have a huge spike in factory investment, and enormous success stories like TSMC's plant in Arizona.

https://www.electropages.com/blog/2024/10/tsmc-arizona-semiconductor-yields-surpass-taiwan-facilities

It turns out that being somebody who is known for being a huge liar who will turn on a dime when bribed, who has a memecoin out in the world creating a super convenient channel for bribes, is just not that good a bargaining position. Sure, companies will try to give him some good news stories to curry favor. But investors don't trust him to keep his word. Trust and certainty are what drive billion dollar capital moves.

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David S's avatar

It seems like liberal democracy and the associated norms are cooked for at least a generation.

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Nathaniel L's avatar

Right, as someone younger than you I think the idea of the Democrats as the party that wants to alleviate poverty is almost non-existent. Hardly anyone would put that at the top of their list of what the Democrats are about (though health care would be up there).

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Dan Quail's avatar

How will the people who order a taxi for their burrito think about the end of ACA subsidies and cuts to Medicaid?

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Ben Krauss's avatar

Not sure I understand the demographic you're referring to?

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JPO's avatar

I think he's expressing doubt that cuts to benefits will trigger big protests - there are more people who get fired up about abortion, LGBT rights, or immigration/asylum because it affects people they personally know, than there are people who will get out and protest against benefit cuts hitting people disproportionately not in big blue prosperous cities.

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Dan Quail's avatar

Poor people do not protest. People who are well to do tend to be the political activists historically and they have the luxury to protest.

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Marc Robbins's avatar

My fear is that the people motivated to go out and protest are the same people we're hoping the Democrats will distance themselves from. People who associate with the Groups, or are at least ideologically aligned with them, are the ones most likely to be the shock troops most vociferous in their resistance to Trump's depredations.

And when you see someone like Amy Klocbuchar talk warmly about her limousine conversations with Trump and Sheldon Whitehouse spark rumors that he may support RFK Jr, you start to worry about where the sensible resistance to Trump may come from.

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Testing123's avatar

Medicaid covers between 18-20% of the population. LOTS of people are going to be personally effected by huge cuts, and even more people will know someone personally that will be effected. Not to mention the impacts on hospitals and health care systems from the removal of billions of dollars of spending from their revenue streams. This notion that Medicaid has only a niche influence on America and it's electorate is just divorced from reality.

https://www.statista.com/statistics/200960/percentage-of-americans-covered-by-medicaid/#:~:text=The%20percentage%20of%20Americans%20covered,of%2019.6%20percent%20in%202015.

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JPO's avatar
Jan 29Edited

It's not that Medicaid doesn't impact a lot of people, it's that the left is more intra-segregated along class lines than one might think.

Liberal suburbanites around Boston, DC, etc. - the pussy hat type people from Trump's first term - are not very likely to personally know people dependent on government benefits. Those people are in the remaining "bad parts" of the city, the exurbs, decaying Rust Belt towns and small Southern towns that were late to running water (this is not a jab, it's a description).

It's an hour and a half from Boston to Springfield, or from DC to Hagerstown, but it's much further in cultural distance. Look at some of the comments here about MAGA voters getting what's coming to them when their SNAP and Medicaid gets cut, and you can see how there will be less outrage about cutting government benefits than there was for restricting abortion rights ("I had a scare when I was young") or LGBT rights ("my daughter's gay") or illegal immigration ("the guy who does my lawn is so nice and reasonably priced, and I don't ask too many questions").

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Sharty's avatar

Dan has as much contempt for casual Doordashing as I do.

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Edward Scizorhands's avatar

I love the casual doordashing. It's idiots throwing money out the window, but I have a bunch of low-income friends and family who boost their earnings by hanging outside those windows and catching the money.

It's a transfer from layabouts to the hardworking and I'll be sad when robotaxis get rid of it.

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GoodGovernanceMatters's avatar

It's also a transfer from people who have limited time to those who do.

It's also batching: It's more efficient for 1 person to pick up food for 5 people than for 5 people to do it individually.

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Dan Quail's avatar

Online slacktivists who say we need to “organize and protest.”

We all know those people in our lives :)

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Cwnnn's avatar

I thought you were referring to the fact that a large contingent of online leftist activists seem to legitimately believe affordable doordash delivery is the most pressing working class issue.

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Joe's avatar

I think he means that it's no longer safe for foodstuffs of color to be out on these Trumpy, ICEy streets alone.

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Testing123's avatar

Not everyone will be up in arms, true. But Medicaid dollars fund hospitals and clinics, and slacktivists have friends and families who rely on Medicaid. I also personally know of an attorney and a retired paralegal who are either currently on Medicaid or just recently were (and that's just because they actually told me- it's not like people are running around declaring "I'M ON MEDICAID!" whenever they enroll), so this notion that the only people impacted by Medicaid cuts are just the destitute underbelly of America is false. Medicaid enrollment is roughly 18-20% of the population as a whole. There are a tremendous number of people who rely on these benefits, so draconian cuts will be felt more broadly than many of you seem to realize.

Also, I would've thought the last election cycle would've dissuaded us of the notion that the uber eats ordering population somehow is a majority of the electorate. Not to mention that demographic strikes me as already overwhelmingly democratic, so they're already voting for the party opposed to these proposals in the first place.

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Eli's avatar

What did you kids THINK Republican government meant? Vibes? Papers? Essays?

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Marissa's avatar

I’m not sure even people old enough to remember “welfare queens” even understand the debate well. I was surprised to learn my Reagan and Trump voting uncle supports making welfare a sliding scale so people who work can still qualify for aid. He’s convinced the reason we don’t have this is because “they” want to keep folks out of work and dependent on handouts. My uncle is not a low information voter by any means so if he thinks this, I can only imagine what younger, less informed voters think about welfare.

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Daniel's avatar

I’m in your age group. And disclaimer: I care. But I don’t think most people our age care.

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Isaac's avatar

The GOP is very good at screaming about trans people (or insert other cultural red meat) to get elected and then immediately pivoting to tax cuts.

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Oliver's avatar

Broadcasting your popular views and not talking about your unpopular views is just competent politics.

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Joachim's avatar

Democrats do the reverse, implement popular policies but talk loudly about their most unpopular positions. Or - to be fair - the left activist part or the party does.

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David Abbott's avatar

When it comes time to pass the tax cuts, our ambassador to Denmark will go into full LARPing mode

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dysphemistic treadmill's avatar

“… nobody describes the concrete materialist stakes like MattY….”

It’s curiously soothing, and helps to quiet the internal scream of constant outrage that tends to paralyze action.

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Francis Begbie's avatar

Get a hobby?

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ML's avatar

But I had to watch three DEI videos at work at work and add my pronouns to my email. Isn't that what's wrong with this country?

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Blary Fnorgin's avatar

Unironically, yes; contempt for people who vote against their own interests because of cultural issues is what got us into this mess. It was naive to think we could shove insulting nonsense in people's faces for ten years and not reap a backlash.

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Lapsed Pacifist's avatar

It's definitely wrong that my wife was confronted at close range by a fully grown, fully naked, fully bepenised man in the women's locker room at the athletic club.

You think this is about videos and email?

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Nathaniel L's avatar

In all seriousness, forcing people to add their pronouns to their email creates a difficult conscience issue for some people. It would create a difficult conscience issue for me.

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ML's avatar

In what sense? Lots of folks on here have pointed out that it can be helpful, absent any question about the meaning of gender, to know what's appropriate with something as simple as unusual or non-English first names. I actually ran into that today. I need to communicate with someone named Karthik, maybe it's not critical that I know how they prefer to be thought of. But it's a little awkward just talking about the email with someone else when you don't know.

I can speak to no one else's religious beliefs, but I'm a practicing Catholic, and I can find no theological basis to address someone by something other than how they ask to be addressed.

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Nathaniel L's avatar

I've also experienced what you described with foreign names; my company includes a woman I only correspond with by email whose first name is Ha. But, while this is a useful externality, we both know this isn't what stating pronouns is about, for either its proponents or those who have concerns about the practice.

I replied to Monkey Staring at a Monolith with my reasoning around the issue.

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Bret M.'s avatar

I have never worked in a workplace that required the use of pronouns in email. I'd be curious to hear from someone who has.

My last firm was certainly the kind of place that encouraged this practice. I never did, not out of any particular ideological objection, but because I couldn't be bothered to dig around the kludgy email system to update my signature block. If anyone cared, no one told me.

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Monkey staring at a monolith's avatar

I don't list my pronouns anywhere, but I wouldn't be upset if I was required to. I'm not sure how this would be a conscience issue.

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Nathaniel L's avatar

Yeah so I wanted to give a better answer than I could dash off before I had to go to work.

The conscience issue involved in calling someone by pronouns other than those matching their sex is more or less what California Josh identified: calling a woman he or a man she is to participate in a lie about the nature of things. Merely stating one's own pronouns, while not a lie-a woman who states her pronouns as she/her is not lying-is nonetheless a tacit assent to a problematic premise: that you need my consent before perceiving my gendered nature, that this part of my nature is my own prerogative to choose, affirm, or re-assign as I desire. In conscience, I cannot affirm that premise. I cannot treat you like you're helpless to know me as male or female unless I explicitly tell you.

I'm not asking you to be persuaded, I'm just telling you my conscientious objection and asking you to believe that more people feel this way about it than you may realize.

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Monkey staring at a monolith's avatar

This reminds me of the whole "I'm just defending the sanctity of marriage" routine opponents of gay marriage tried in like 2009.

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Nathaniel L's avatar

Well yes, it is like that, although I'm way too young to have participated in those debates. But this isn't a 'routine' that I'm 'trying', it's just a settled conviction that follows from more fundamental commitments I hold. It's not a mask for some bigotry. If you look at my comment you'll see that the emphasis isn't on what other people do; it's about what I do.

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Josh Frandle's avatar

Typically I see this line of thinking countered by separating the terms Gender and Sex. Male/Female is determined by chromosomes sex characteristics etc. Man/Woman is more analogous to the term "Gamer" in that it implies a general set of stereotypical behaviors and appearance disjoint from biology.

Functionally, I don't see how referring to trans people as their preferred gender is any different than dealing with a non-trans but gender-ambiguous individual. You guess, and if you guess wrong, you shrug and change your wording. We've always had to do this, why is it any different now?

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California Josh's avatar

It requires subscribing to the belief that people can be anything but men or women

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Monkey staring at a monolith's avatar

I mean, can't people be something different? There are intersex people.

I also have personally found pronouns useful even when dealing with people who seem to be garden-variety women or men. For example, when emailing overseas coworkers with names that are uncommon in the US.

I also have to say that despite living in a fairly blue area and working for a company that makes a big deal of LGBTQ stuff, 99% of pronouns seem to be "she/her" or "him/his." The remaining 1% are "they/them." I don't think I've ever seen anything else. It just... doesn't seem like a big deal?

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California Josh's avatar

Intersex people are either biologically male or biologically female, but I'm not opposed if an intersex person wants to use different pronouns. They are quite different from typical men and women.

But you know as well as I that the movement for pronouns is not about intersex people.

If 99% of people are their expected pronouns, asking everyone to use them all the time is a waste of time. We don't expect everyone to go around and say if they have dyslexia, even though it is to some extent useful to know which of your colleagues do

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Blary Fnorgin's avatar

Accidentally misgendering someone is also not a big deal, or at least it shouldn't be

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PhillyT's avatar

Not always, there are people with unisex names, and I've worked for many multinational companies, where people simply use the pronouns so they get addressed properly. Not everything is so deep...

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California Josh's avatar

Then they can do that, and I, who have a basic name that is easy to understand and work at a US-only business, can keep not using any in my email signature

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Guy's avatar

Yes, because that made it credible that Trump cares more about ordinary people than Democrats do

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Dave Coffin's avatar

It's remains incandescently stupid that the only bipartisan sacred cow is transfers to wealthy retirees. No side in these budget fights is defensible as long as Social Security is an unfixable political quagmire.

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Bennie's avatar

Social Security was intended to keep seniors out of poverty, not supplement the already comfortable retirement of someone with a fat 401K living in a house worth 4 times what he paid for it (like me!).

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MagellanNH's avatar

I don't think that's correct. As I understand it, from the start, SS was conceived to be an insurance program first and foremost. This was part of a plan to make sure it had broad support by the public and wasn't just viewed as a welfare program. The goal from early on was to provide retirement income to people from all walks of life.

The SS benefit formulas did also contain some transfer payments from richer to poorer earners, but it was never intended as a poor people only retirement program.

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Bennie's avatar

"Insurance" against what? Poverty. If I'm not poor, why should I be able to make a "claim"? My car wasn't stolen, but maybe I can make a claim on my auto insurance?

(Or did you mean insurance against getting old? In other words, like a life insurance policy except it pays out to everyone who hasn't died. I'm sure a good actuary can figure out how to make that work.)

As a pay-as-you-go system (or, more uncharitably, a Ponzi scheme), SS can't and won't pencil out like a pension fund paying everyone an "earned" benefit.

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MagellanNH's avatar

The insurance aspect of SS is that it pools longevity risk.

It's difficult and inefficient to plan cash flows that last for an uncertain time period, as is the case with retirement planning.

Pensions, annuities, and social security are basically insurance products that pool an individual's longevity risk and promise a payout that continues for however long the recipient lives.

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Dave Coffin's avatar

It's also not intended to facilitate spending almost 1/3 of your life not working.

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MagellanNH's avatar

As I understand it, the changes in life expectancy only make a small part of the funding shortfall. The main issue with sustainability is that the demographics worked out much worse than projected.

I think the latest trustee report says SS could fund roughly 75-80% of benefits indefinitely without any changes. Of that shortfall in funding, about 20% is due to errors in the program's longevity projections and 80% is due to errors in their demographic projections.

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Helikitty's avatar

Yes it is

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Robin McDuff's avatar

And me.

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Lisa J's avatar

I would add here the military. You might argue it’s not bipartisan but I think it largely still is, everyone loves to say they support the military. So we keep shoveling money at it without scrutinizing how well it’s spent.

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Sean O.'s avatar

Military spending as a % of GDP has dropped a lot from its highs in the 1940s and 1950s. Arguing over military spending now is pennies on the dollar of what it used to be.

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CarbonWaster's avatar

That's true, but it doesn't prove either that the budget is the right size or that it's well spent.

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Sean O.'s avatar

I'm not arguing that the Pentagon wastes money, because it does. But when people argue for reducing military spending they usually mean shrinking the global presence of the American military. If you believe China should be the global hegemon then make that argument directly.

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Gordon Caleb's avatar

I work for a defense aerospace company. We just raised our prices 3x-4x, meaning the government is now paying 3x-4x more for our product.

The new prices slid through easily. Nobody even batted an eye. And we certainly didn't change anything.

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Davis's avatar

Man, I chose the wrong industry.

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Kade U's avatar

We maintain enormous military presence in Europe guarding countries that should be perfectly capable defending themselves, and none of that is warding off China's hegemony. I would be much more comfortable with our level of spending if I believed that the majority of it was spent containing the influence of our only real rival in the Pacific, but instead we mostly use it to subsidize European national budgets.

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Marc Robbins's avatar

If we were very serious about confronting the China threat, we would rebalance military spending. A lot more on the Navy and the Air Force (and probably Space Force); vastly reduce the Army and change its focus more toward missile defense and special ops; probably shrink the Marine Corps, but that's so small and cheap there wouldn't be any savings.

None of that will happen because the only threat that's greater than an enemy military is another Service getting your money and taking away your roles and missions.

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mathew's avatar

That's true, if anything military spending is too low

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Dan Quail's avatar

Even the 80s and 90s

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Daniel's avatar

Given the national security challenges on the horizon, realistically any scrutiny of how the military spends money is going to result in the military continuing to spend that amount of money, just more efficiently, rather than reducing the amount spent.

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Lisa J's avatar

That would at least be a fruitful exercise! It seems like the Congressional discourse just assumes more military spending is good.

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JPO's avatar

https://www.nationalreview.com/2022/03/we-need-a-1-trillion-defense-budget/

Such an annoying piece that I remember it three years later - defense is the only part of the budget where conservatives assume that shoveling more money into the system directly results in more of the desired outcome. Spending a trillion on defense is easy, just take the current budget and cut Raytheon a $200 billion check for a couple hammers. But actually making sure that spending, both current and potential new spending, is being done efficiently is hard and unsexy.

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Dave Coffin's avatar

I agree, though the problem with military spending tends to be a morass of special interests and pork that is harder to go after systematically.

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Marc Robbins's avatar

Most military spending is on paying service people and for operations and maintenance. We should do acquisition better and that would yield some savings (and better equipment) but it's not the big bill payer for the Pentagon. If you want lower defense spending, you have to cut the size of the force and reduce what it does. In the meantime, you can look for efficiencies here and there, but that "fat" is so marbled in the muscle it will be very hard to cut just the waste in general.

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Davis's avatar

Given that future wars are obviously more likely to be technology-based, and maybe even better characterized as cyber-wars, shouldn't we be aiming to slowly reduce the # of personnel? My fear is that Congressional reps care more about the subsidy to their districts' economy via head count at bases than about the actual effectiveness of the military.

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Marc Robbins's avatar

Quite possibly.

In fact, manpower has trended downward — falling 38% since 1988 and 11% since 2010. More UAVs and robotics could certainly increase that downward pressure, especially as we start to see more demographic pressures.

https://www.macrotrends.net/global-metrics/countries/usa/united-states/military-army-size

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Lisa J's avatar

Yes on this. And purely anecdotally I can say that programs at the Pentagon can be just as badly and bureaucratically run as any social program.

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Nathaniel L's avatar

'incandescently stupid'. Seconded. Let's please just means test social security instead of cutting food benefits for the poor.

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Lex's avatar

If there are work requirements for Medicaid, I say it’s only fair we institute them for Medicare too! #amodestproposal

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Mr. Toucan's avatar

Once the boomers die and lose their political power, the Millennials and younger generations will be able to outvote the Gen Xers and rein in social security. Until then, boomers will continue to vote for their wealth transfers and millennials will continue to vote for wealth transfers to their parents.

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Jimmy Waller's avatar

“Hoping to get $2-3 billion worth of cuts” < typo? Seems like 2-3 trillion is correct here

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Ben Krauss's avatar

Damnit I should have caught that. I'm sorry!

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Edward Scizorhands's avatar

2 billion here, 3 billion there, pretty soon you're talking about real money.

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Michael Lipman's avatar

Yeah, the link says trillion and the context makes it clear it should be trillion

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JPO's avatar

Honestly I was like "seems low but plausible if Republicans are doing the usual 'cry about deficits, then cut taxes and not spending and blow up the deficit' thing."

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John from FL's avatar

The Republicans have learned their lesson with respect to Social Security and Medicare. I don't think they will ever propose changes to these programs after the drubbings they received when Bush proposed private Social Security accounts and Romney proposed Medicare vouchers.

So, yes, they will cut aid to poor people. And as sanity returns to the Democratic Party on cultural issues, I predict (or at least hope) these constituencies will fade away from the Republicans.

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David R.'s avatar

There's always *just* enough of the old efficiency-seeking rhetoric, the product of some vestigial parts of the Republican genome, to make observers think that maybe they'll get a bit of good done to go with the bad.

And then they prove that, at the federal level, they can't undertake permitting reform, reform NEPA, mandate site-neutral payments in healthcare, require unified rate-setting, reform university funding, maintain IRS enforcement, or any single action, no matter how trivial, that might even *slightly* impair rent-seeking by large capitalholders and SME owners in any manner.

Sigh.

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JPO's avatar

This is the crucial difference between being pro-market, and pro-business. Republicans are the latter.

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David R.'s avatar

You'd think that the pro-business aspect would be enough to get them to actually engage in a bunch of deregulation and permitting reform. The only oxen it gores vote heavily, insanely Democrat. What Republican gives a shit if the environmental law firm has to fire people, or the HR department gets downsized by half because a bunch of regulatory and compliance tasks were sunset?

And yet they just can't seem to do even that, despite both spite and donor pressure militating towards it.

I'm really at a loss here.

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Blary Fnorgin's avatar

I think about this a lot. I remember when Rs campaigned on this. Now they seem to have lost interest. Although I was encouraged by the press conference with Trump and Karen Bass, where he was railing against 18 month permitting delays for rebuilding from the fires.

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David R.'s avatar

Sure, but LA County is currently on track to deal with that in the most illegally stupid manner possible: attempt to ignore state law entirely so long as people build the exact same stick-framed building in the same location with the same footprint.

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GuyInPlace's avatar

Even then, their tariffs are also likely going to be bad for business and the market.

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Eric C.'s avatar

Not to gloom your doom but haven't they already signed EOs to reform NEPA? I'm not a policy expert but the people that are [1] seem happy.

[1] https://www.greentape.pub/p/the-permitting-eos-part-1-ceq-gets

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David R.'s avatar

It's about a tenth of a loaf, thus far. Until they actually come up with and pass a set of reforms through Congress telling the agencies what thresholds they are to use in evaluating phrases like "significantly affect," they're going to converge on something similar to what existed already out of a combination of institutional inertia/laziness and the bureaucrat-to-lobbyist pipeline kicking into overdrive to preserve/grow the consultants' slice of the pie.

I don't think the GOP has it in them, literally in the sense of lacking expertise or even basic competence, to actually out rules-lawyer the lawyers and consultants on this. If I were in their position I'd be angling for an outright "repeal and replace" framework, with the replacement standards sufficiently environmentally sound to get 10-15 Senate Democrats on-board with the whole endeavor. What they'll actually do is nothing.

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David Abbott's avatar

My assumption is that the working class voters who have swung towards Trump are significantly above the Medicaid and SNAP eligibility thresholds.

If the cuts are properly targeted, this could work politically

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Dr B's avatar

When looking at campaign donations, “People on disability” is the single most Republican leaning profession aside from homemakers. No one seems to be talking about how, for better or worse, this is going to completely destroy rural areas.

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Ben Krauss's avatar

Bad for rural hospitals, that's for sure.

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Testing123's avatar

Bingo. That's what makes me somewhat less pessimistic about some of the more draconian proposals relating to Medicaid. The R's can only lose a few votes in the House, and many of those jurisdictions would risk gutting their only hospital with some of the more extreme cuts.

I anticipate a lot of pretty horrible policy changes to come down the pipeline for Medicaid in the next few years, but I think those considerations will at least prevent some of the absolute worst proposals from getting through Congress.

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Jan 28
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EF's avatar

wow, that seems very high. I wonder how skewed to data is to 60-65 (or is the upper bound of 'working age' higher than 65 now?)

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Jan 28
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David Abbott's avatar

How many of the “people with a disability” are veterans receiving benefits?

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Thomas's avatar

How representative of "people on disability" are "people on disability who donate money to political campaigns"?

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unreliabletags's avatar

Vance’s whole thesis is that even the people involved feel on a deep level that this is ridiculous, and while they lack the wherewithal to individually opt out they will, as a class, be much happier and better off without it.

He could be wrong about that, of course! But it’s not like they didn’t think about the issue.

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InMD's avatar

I think you may be right. Someone can correct me if they have the data but I don't think this works to the extent able bodied working class white and hispanic voters (and increasingly working class black men) are the contested demographics. They don't have the lifestyles of the coastal upper middle class but they aren't likely to be relying on SNAP or Medicaid either.

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Richard Milhous III's avatar

I don’t have data to back this up, but qualitatively, a common refrain from the Trump base I heard was “Work too much and make too much money for welfare, but not enough to be wealthy, who look down on us more than the welfare recipients”

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JPO's avatar

I actually agree this is a problem, but the answer is to broaden Medicaid to cover higher earners, not to gut the program and fuck over poor people.

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Edward Scizorhands's avatar

If we simply let anyone be on Medicaid as long as they weren't on any other insurance, how much would that bust the budget? Selection effects seem unlikely because Medicaid is pretty weak coverage.

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TR's avatar

It's also a backdoor to public healthcare for all who want it. It's weak coverage, but there's nowhere in the world where public healthcare covers everything that might benefit the patient, even the best health systems have budget limits, cost-effectiveness considerations, and political considerations.

I've heard stories about the crap that private healthcare gets away with. Having something else to compete with it should help make the worst private plans non-viable.

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InMD's avatar

I think you're right on the larger policy question, that we should be looking to close the gaps. Unfortunately it doesn't really address the politics question since the people whose support is needed aren't impacted, or maybe aren't impacted in a way that seems directly attributable to the GOP running the government.

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Richard Gadsden's avatar

I still think that (British Labour politician in the early 2010s) Ed Miliband's description of these people was really powerful: "squeezed middle".

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James C's avatar

I would also observe that in general in political commentary and analysis there is remarkably little focus on those who are middling. A lot of focus on the elite (whether defined by assets, income, or education), and a lot of focus on the poorest, but the typical voter is neither.

I'd also guess - but couldn't prove without further analysis - that people/families at the 40th and 60th income percentiles don't see their circumstances as being all that different, whereas moving from the 20th - 40th and 60th - 80th you're moving between people who perceive themselves quite differently.

A concrete example in UK wonkworld might be how in transport policy it's often observed that the majority of the poorest 10% don't drive, so we shouldn't worry so much about policy changes leading to higher costs for motorists. While this fact is true (only c.35% of UK households drive cars among the poorest decile), you don't have to go much further up the income spectrum to find a massive majority who drive! It jumps to 54% (10th - 20th), then 71% (20th - 30th, then 80% (30th - 40th) and rises marginally every decile thereafter except the very richest. So lots of income constrained people - albeit not a majority of the very poorest - will be hit hard by greater motoring costs (and will obviously have less ability to invest more upfront to try to minimise them in the long run).

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NYZack's avatar

I think almost 20% of the population is covered by Medicaid (higher in blue states), and more then 12% is covered by SNAP.

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StonkyMcLawyer's avatar

Yes, but all that matters is voting population (a disproportionate percentage are kids, and the voting eligible beneficiaries mostly don’t vote) and the distribution of voters within. It’s not a large percentage of voters and many of them already vote democrat.

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InMD's avatar

I guess the question becomes whether and to what degree their voting behavior has changed.

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BronxZooCobra's avatar

In many states more than 50% of Medicaid spending is on nursing home care for the formerly middle class.

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David Abbott's avatar

Are you assuming that all medicaid funded nursing home residents were “formerly middle class”? If so, that’s dubious. Many middle class people pay for private assisted living.

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Colin Chaudhuri's avatar

If they do I think it's because a lot of people don't get that a disproportionate number of people who are on Medicaid are actually the elderly; a group that famously shows up more in off year elections than younger voters.

I think these Medicaid "work" requirements are really about playing into people's biases about who does or doesn't get Medicaid or "welfare" (in the broadest sense of the word) generally. I'm pretty sure Matt has brought this up before, but these "work" requirements are pretty ineffective only serve as a backdoor way to slash Medicaid https://www.kff.org/medicaid/issue-brief/understanding-the-intersection-of-medicaid-work-a-look-at-what-the-data-say/

I'm not surprisingly in a down mood right now, so take this with a grain of salt, but I think a lot of working class voters who voted for Trump and may actually be harmed by Medicaid cuts will still vote for GOP for culture war reasons. A whole lot of farmers were significantly harmed by Trump's tariff policies first term and it seems to have done nothing to sway more than a handful from voting for him a second time.

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Blary Fnorgin's avatar

I fear you're right, and I think it's all the more urgent for liberals to publicly stand up to the left wing culture warriors & send a signal to working class voters

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Nathaniel L's avatar

Yeah it's really a shame that the Democrats have managed to aversion-therapy the Republican party away from any reforms to social security. Unlike SNAP, lots of people are collecting social security who don't need the money and wouldn't suffer from having it reduced.

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mathew's avatar

Yes the correct answer needs to be reforming SS, Medicare and Medicaid.

I'm willing to tolerate small increases to the payroll tax if we get the spending cuts needed to prevent fiscal calamity

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Dan Quail's avatar

There is so much sloppy, stupid, and poorly written stuff coming out of this White House. I don’t know if it’s that their lawyers are incompetent, if they just have contempt for the law and written word, or both.

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James's avatar

On the other hand, as comedy writers they’re doing really well. I loved the tariffs they levied against Columbia… university? South Carolina? Sportswear? Certainly not the nation of Colombia.

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Ben Krauss's avatar

Lack of intellectual rigor on the left, lack of straight up intellect on the right.

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Edward's avatar

Does adding the tech bros help the Rights intellect problem?

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Ben Krauss's avatar

It's a good question. I think so. But as we saw from the chaos and insanely bad management of the past few days, it doesn't translate to good governance.

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TR's avatar

"contempt for the law" has already been proven beyond reasonable doubt. I can only hope that the lawyers are also incompetent, and that the judges still have more loyalty to the law than to the Orange One.

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Dan Quail's avatar

I think most conservative judges don’t like being treated like they are morons. That is why Judge Cannon is so offensive. She gives deference to nonsensical claims using arguments not even made by Trumps lawyers.

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TR's avatar

My concern is that such behavior, and Trump's ongoing support for it, create a new norm. As with other Trumpified things, the attitude may switch from "they think I'm an idiot for accepting such nonsense about the law" to "I'm smart for coming up with novel excuses to get what the boss wants."

It reminds me of the cynical gloss on originalism, "Well, that's certainly an *original* interpretation of the law!"

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StonkyMcLawyer's avatar

Especially when Cannon is elevated to the 11th Circuit and whatever actual conservative legal thinkers who remain are drummed out of Republican controlled spaces entirely. The incentive structures are already very clearly working.

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Kade U's avatar

This ethos of just being sloppy and stupid permeates the whole enterprise. The proposals are just so lazy. Take the medicaid per capita limits. It's absolutely true that there's some fat to trim in medicaid's coverage of high-need disabled people. There are people who get pretty expensive at-home care from nurses around the clock, and oftentimes these are not really people who *need* an experienced medical professional on hand at all times. One could imagine a wide variety of attempts to restrict these payouts in clever ways -- maybe we try to relax some sort of regulatory environment so that more of this work can be done by CNAs rather than nurses, or maybe we do partial reimbursements to families that choose to handle the caregiving themselves to incentivize them away from hiring these agencies. Instead, they just throw their hands up and say "welp, we will just put a hard cap on the amount we pay to anyone. Job's done!" And they do this because they are not really sincerely interested in making smart, fiscally prudent reforms to these programs -- they are like an underperforming employee who figures out the minimal amount of work required to not get fired.

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Colin Chaudhuri's avatar

Can I just note here that there is a strong likelihood that if GOP plays its cards right, it can get a handful of Democratic votes for any bill they pass as long as it includes reinstating the SALT deductions...and how asinine that is if it comes to pass.

Little anecdote. My wife and I gave a decent amount of money to the Laura Gillen campaign for Congress. It was a tight race and it was our home district so easy decision to prioritize giving money to this race. In the end she won by a tight margin so money well spent I think. Anyway, we actually attended a get fundraiser/get together at the home of one of her biggest donors. She showed up and of course did a version of her stump speech and one of the items she brought up was how she was going to vote to bring back the SALT deduction.

Now politically I get it. This is a district with a decent amount of educated high income voters who were once Republicans and now have swung at least centrist. Considering her margin of victory, probably the smart political move. But I can't emphasize enough how much the people at this fundraiser were people who in no way shape or form needed the SALT deduction. Again, we could all afford to provide enough money to be at this fundraiser in the first place for one.

And so reading Matt's post that the likely scenario is that GOP will "pay" for this windfall in part by cutting Medicaid to children is just almost just "chef's kiss" too on the nose for how cartoonishly evil I find all of this to be.

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Nicholas's avatar

I'm old enough to remember bits and pieces of George W. Bush being president, but not old enough to remember the intricate details of early aughts budget fights or the social security privatization push in 2005. Realizing a slow news week might be a precious commodity for the next four years, if things ever do slow down, I would appreciate Matt doing a deep dive into the merits and arguments of this fight over social security privatization. As a good slow borer, I understand voter's inherent status quo bias and change aversion. Getting rid of a popular domestic program after an election that was fundamentally about national security seems like a reach.

But I sit here as a finance bro lawyer looking at the S&P 500 in January 2005 being worth ~$1100 and over $6000 today and think damn what could have been? This is way beyond the value of inflation over the same period. In someways it seems like social security privatization was the GOP's version of medicare for all, they never could convince people that after the disruption a la ending private insurers, what they would get would be better.

But is that true? It's hard to find good accounts of a 20 year old political fight. Was this a failure of design/implementation or was it damned from the start? Or was it just killed by bad politics amidst an unpopular war? And what does that mean for how dems should think about structuring social security?

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Matt A's avatar

The point of SS isn't to raise the ceiling on the lifestyle seniors can live post-retirement. The point is to set a floor above poverty. It's a deliberately paternalistic forced savings program because people can't be trusted to save properly on their own. If you buy into that framework and goal, then you probably also believe that the logical endpoint of prioritization is bankrupt and destitute septuagenarians who got scammed by someone hawking REITs and gold (back in 2005) or memecoins today.

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Lapsed Pacifist's avatar

Point of order: SS is not forced savings. It's a direct payment entitlement paid by people currently working. There is no savings component at all.

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JPO's avatar
Jan 28Edited

100% correct - sometimes you want to accept subpar returns for stability and safety, and that's absolutely what we should be doing with the funding for elderly people's retirement that we collect via payroll taxes. You want to privatize Social Security, just go all the way and end both the program and the payroll tax, but the outcomes will be awful.

Realistically, of course, any phaseout of Social Security would require maintaining the payroll tax to fund current beneficiaries, even as those paying it would never get Social Security themselves. Honestly I'm surprised this hasn't happened yet, because it would fit perfectly in line with the tendency to fuck over younger and middle-aged people in favor of retirees who in aggregate are better off anyway.

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drosophilist's avatar

“Prioritization” = “privatization”?

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Matt A's avatar

Yes. Important typo, that!

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mathew's avatar

Yes but it depends on a good ratio of workers to retirees that we no longer have

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splendric the wise's avatar

Matt has written previously about it a bit:

https://archive.thinkprogress.org/mike-pence-2d484a554a54/

He noted an issue where we'll face political pressure to bail out seniors who have portfolios that underperform, but bailouts would create moral hazard which encourages everyone to make riskier investments. Apparently, at the time, this issue was not addressed well by proponents of privatization.

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A.D.'s avatar

The moral hazard is the biggest reason I ended up deciding I opposed privatization. My initial gut reaction was to support it but I couldn't convince myself we'd solve the moral hazard problem so I changed my mind.

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Ethics Gradient's avatar

I think this is the primary argument, the secondary one is that forcing any kind of discretionary asset allocation on to individual seniors is stupid -- most *hedge funds* can't beat the market. Why would we ever expect the discretion of a bunch of aging people who may or may not have ever owned stocks to have good outcomes?

And if your response is "we know the good investments, we'll tell the seniors to buy index funds and/or make it hard to opt out of doing so," my response to that is "then why the hell do you need to privatize any of this instead of just using the Social Security trust fund to buy index funds rather than investing in worthless Treasuries? How does that do anything except create new ways for people to fuck it up?"

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A.D.'s avatar

1) The argument isn't for seniors to buy these, it was for young people to buy them so they'd have more money _as_ seniors. Once I'm living on social security I'm not spending it on index funds. So it's not "the discretion of a bunch of aging people who may not ever have owned stocks"

Since it's younger people, they _also_ don't know _yet_, but there's more room to give them advice on it and educate them, and maybe this would actually increase education on these things.

2) I didn't want the government picking which private index fund to invest in, wanted it more open to the market for people to pick which one. (Fine with something like the CFPB providing requirements/grading on some)

3) Given that index funds typically do better than treasuries, this made sense to me as a way to decrease future social security shortfall without having the government explicitly slush _its_ money around. (But of course this doesn't work if people take high risk investments and then get bailed out - it just makes it _worse_. )

For me though yeah, since there was no universe in which I thought future me wouldn't want to bail out the seniors who had lost all their money on bad investments, then the advice would be "you must buy index funds" and then you've certainly scaled back much of the freedom this provided (without even completely eliminating the hazard, if the market did actually crash). But for me that's still downstream of the moral hazard issue.

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Thomas's avatar

Could we write a set of rules that you have to follow to qualify for a bailout? There are private funds you can buy into that guarantee a floor on your returns. Do we think "follow these rules and we'll guarantee some minimum payout" would work? Or do we still expect people to take the high risk pay and get bailed out?

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Edward Scizorhands's avatar

> Could we write a set of rules that you have to follow to qualify for a bailout?

We could, but those rules go out the window if there's suddenly a disaster and a bunch of people need help.

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Thomas's avatar

I thought the concern with having the government invest the SS money itself was that it would massively distort the market and create opportunities for corruption.

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Colin Chaudhuri's avatar

Well that too. And also see my Keynesian point. A serious market downturn prior to 2008 and 2020 would seriously hamstring the government's ability to respond to economic crisis if the government was heavily invested in the S&P 500. It was also create all sorts of terrible incentives for Congress and the President to pass laws that temporarily boosted stock prices artificially to cover funding gaps or just increase government coffers generally.

I think the 2005 social security privatization really needs to be seen in the context of the "Great Moderation" from mid 80s to 2007. There really was a sense that the threat of major economic downturns had been "solved". Yes there would some gyrations in the economy and maybe GDP growth might slow down. And maybe you'd have two consecutive corners of very modest employment drops. But all you needed was the wizard Alan Greenspan to say a few words, cut rates by 25 bps and presto! problem solved (can't be emphasize enough how high Greenspan's star was pre 2008).

I think there really was this "end of history"/"world is flat" mindset that the great economic problems were solved and that classic Keynesian economics however welcome and necessary it was in say the 30s was past it's shelf life.

Turns out post 2008 not so much.

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Ethics Gradient's avatar

It would probably have problems relating to pricing but I don't think it has any real corruption-related issues. VTI and/or VOO don't really create much in the way of opportunities for graft.

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JPO's avatar
Jan 28Edited

It just seems like it'd be simpler to achieve the goal via ending Social Security and requiring enrollment in and contribution to a 401(k), isn't that the same outcome?

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StonkyMcLawyer's avatar

Not really, at least not without more reforms. When I leave a job, I can move my 401k into an IRA and bet everything on options or leveraged single issuer ETFs.

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Ethics Gradient's avatar

Having read that article I do think Matt's take on the source of moral hazard and the behavioral incentives is somewhat off-base and Pence's view actually more correct than 2008-Matt gives him credit for. The presence of an annuity-baseline-guarantee shouldn't in general encourage riskier investing in and of itself if the guarantee is below the market rate of return. This is conceptually similar to the way that a minimum wage below the market wage doesn't really do anything.

Your goal as a rational investor is going to be to maximize expected value. In the absence of private knowledge giving you alpha, that basically means buying index funds (rather than relying on the annuity guarantee), and you would only take the opportunity to gamble on individual stocks if you thought it offered higher *EV* (i.e., *risk-adjusted*) return than VTI / VOO or whatever, not merely the chance for higher payoff than the annuity.

Matt's somewhat glib statement in the article that "[Pence] seemed unaware that some portfolios are riskier than others, or that higher average rates of return are associated with greater risk taking" appears (in context) to be analogous to saying "Pence seemed unaware that the easiest way to become a hectomillionaire overnight was to play the lottery," -- yes, it is in fact true that the highest return high returns can be made by adopting high risk strategies, but you'll notice that playing the lottery is generally considered stupid because it's *negative-EV.* Trying to outperform the market rate or return is generally going to be a mug's game for investors trying to maximize total return, whether or not there's a below-market-rate-of-return annuity floor[1] - and in this sense I think Pence is right that the moral hazard risk from the perspective of individual rational investors isn't that great.[2]

Instead, the primary moral hazard is that some *irrational* set of poor investors or risk-loving idiots make bad investments and need to be bailed out by a bleeding-heart Congress, but this isn't really a function of the annuity guarantee, because as we've already seen the guarantee shouldn't affect rational investor behavior. The moral hazard is Congress not having the will to let foolish seniors starve, not that we're distorting rational behavior incentives of invidiual investors to bias them towards high variance plays in way that results in more such impoverished seniors.

[1] Obviously if the annuity floor is above or at market-rate, you want to buy the lottery tickets because the only way to get more money than the annuity is to go all-in on variance, but then you're basically talking about playing with house money.

[2] Matt's right that it isn't zero, and in particular the closer the annuity guarantee floor is to a market RoR the more distortative it is, but given the historical performance difference between Treasuries and stocks since 2000 I think seems likely that for most individual trades it wouldn't be highly distortative.

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JPO's avatar

"bailouts would create moral hazard which encourages everyone to make riskier investments"

After tax cuts, this is what the establishment GOP lives for.

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mathew's avatar

That could be fixed by requiring balanced portfolio.So index funds combined with bond funds or something like that

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Sean O.'s avatar

Such a system would have generated massive wealth for seniors, except in 2008 and 2020 it would have also generated mass violence.

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Colin Chaudhuri's avatar

I think the 2008 crash should put the nail in the coffin as to why this would have been a terrible idea.

As noted below, a lot of people would likely have made terrible investment decisions and Matt noted in a old ThinkProgress post that this would have created Moral hazard.

But the other big problem is the stock market crash would have absolutely devastated the finances of recently retired people who had invested their social security in private accounts. Any cursory reading of Keynesian economics would tell you how terrible this would have been in an economic crises. A huge reason 2008 was not as bad as 1929 was the presence of automatic stabilizers. Seriously weaken one of those stabilizers and you would have a serious headwind against stabilizing the economy. The problems with "Paradox of Thrift" would be exacerbated tremendously. People between 55 and 60 would suddenly be a lot more constricted in their ability to spend money. One person's spending is another person's income.

But given the parameters of the 2005 privatization bill, maybe only a handful of people would be devastated as it was designed given it exempted people already retired. What happens in March and April 2020 when a lot more more people have their social security in private accounts. Do you know much larger the stimulus would have had to be to plug the gap?

That's the thing with safety nets in general. For large portion of our lives we don't actually need it. If you're not elderly there's a decent chance you're healthy most of the time and those times you are not you usually just need a few days in bed to recover. Most of us are actually employed most of the time between age 22 and 62, so no need for any extra help if you have benefits through your employer.

Which is part of the problem. A lot of this cutting the welfare state stuff in general is a bit tossing out an umbrella during a drought because you think you'll never need it again.

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Marc Robbins's avatar

Yes, the stock market has had a great run. However, if you had retired in 2009 and gone on Social Security, you would not have been very happy.

Also, keeping it safe from the rollercoaster of the stock market is not only good for individual security but is an excellent counter-cyclical stimulus for downturns.

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David Abbott's avatar

I remember being shocked that Medicaid expansion didn’t help Democrats with the white precariat. I was once innocent.

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John from VA's avatar

The attempt to remove it proved extremely costly for Republicans in Trump's first term.

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Blary Fnorgin's avatar

Genuine question: How do we know it didn't?

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David Abbott's avatar

Democrats got their ass kicked in the 2010 midterms and underperformed with the white working class in 2012.

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Tom McNulty's avatar

The Medicaid expansion didn't kick in until 2014. Though, to be fair, Dems got drubbed that year too

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David Abbott's avatar

Passing a bill that took four years to take effect was retarded

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TR's avatar

In at least one sense of the word, maybe more.

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David Abbott's avatar

I’m trying to teach my 11 year old to cuss cleverly. Constant dropping of f bombs is tedious and low status. Punning with naughty words deserves encouraging laughter

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What-username-999's avatar

I hate that half the country inflicted us with at least two years of this.

I’d want them to suffer for it, but I’d really just rather it be over.

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StonkyMcLawyer's avatar

They’ve wanted you to suffer. Now they’re trying to cause just that.

We’re in trouble as a country in part because people are too guided by retribution as a political motivation.

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Pas's avatar

They are already suffering from less than average empathy (and intelligence and income and ...), hence their lashing out. The following axiom holds here too "if suffering would make people kind everyone would be Mr Rogers"

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Spencer Roach's avatar

"It’s inevitable that something big will happen here because it is genuinely inconceivable that Republicans would just let the Tax Cuts and Jobs Act expire."

I agree this almost certainly won't happen, but it would be genuinely hilarious if they didn't get anything done because they couldn't. New fantasy unlocked

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Dan Quail's avatar

Someone dies, the special elections go weird, etc.

The reason we didn’t get a public option was due to Ted Kennedy dying and being replaced with a Republican.

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Eric's avatar

I was going to make a snarky comment about what goes around comes around or the leopards eating people’s faces party. The comment section already has plenty of that though.

So instead: in 2024 people voted for Trump because he’s funny and they dislike trans people. I suggest this is like George W getting votes because he’d be more fun to get a beer with than Al Gore and cos America needs to protect the sanctity of marriage.

Times will get tougher and people will vote for the more responsible party again. Just like they have before. It’s unfair that this is how it has to be for the Democratic Party to win but that’s the breaks when a country has but one serious party.

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drosophilist's avatar

Re:your last paragraph, I hope you’re right and that the damage isn’t too catastrophic in the meantime.

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mathew's avatar

The democrats did not prove they were the more responsible party over the last four years.

Their policies made inflation worse

Created an immigration crisis at the border

Left afghanistan in a disastrous retreat

Pussyfooted with packing the court

Not to mention the unconstitutional actions like trying to forgive student loans

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Matt S's avatar

Just pointing out, "more responsible party" and "responsible party" are very different benchmarks

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mathew's avatar

fair enough. Either way it's a pretty low bar.

Though I don't think voters really want a responsible party. If so we would have fixed entitlements and the budget deficits year ago.

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John from VA's avatar

I think Trump gained support because people felt that his policies will help them more than Democrats. When that turns out to not be true, what happens?

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fortiessomethingdad's avatar

When this happens, it seems too easy to communicate directly to people who will be hurt by this and voted for Trump what is happening and yet somehow I am sure Democrats will screw it up.

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splendric the wise's avatar

The people who will be hurt by Medicaid and SNAP cuts probably don’t vote much. (Children can’t vote at all.) That’s what makes them “weak claimants”.

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David Abbott's avatar

Are children weak claimants. Middle class women are not okay with hungry children. Many middle class men aren’t either. This includes conservatives. The thing is, feeding children is cheap. Medical treatments for obese non workers are expensive

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CarbonWaster's avatar

And yet elected Republicans do, in practice, often use power to limit financial support for nutrition-deprived children. I think you overestimate your middle class men and women; most people actually care about their own family circumstances. They might care about others in the abstract or if a problem is directly drawn to their attention as it somehow makes the top of the news cycle, but mostly people aren't that fussed.

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David Abbott's avatar

I think republicans are somewhat ashamed of hungry children, as evidenced by their efforts at deflection. some republicans think defunding poor kids is worth the human costs, but very few are comfortable with those human costs

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StonkyMcLawyer's avatar

Just call them illegal anchor babies and children of unwed black women. It doesn’t really matter what’s fact. At this point, you’ll get those same people cheering for the suffering as long as they can convince themselves it’s the right people doing the suffering.

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David Abbott's avatar

How much should influence a group that is unproductive and too demoralized to vote have?

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Tom Hitchner's avatar

Aside from “demoralized” you just described children.

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Thomas's avatar

In fairness to children they're legally barred from both working and voting so I don't think we can blame them.

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David Abbott's avatar

Totally different because they have more remaining productive capacity than adults

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Thomas's avatar

And that entitles them to have "less" influence than adults do?

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JPO's avatar

What contribution to national GDP should let you have a say in how your country's governed? Where's the cutoff between unproductive and productive?

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David Abbott's avatar

the dollar cost of subsistence comes to mind.

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David Abbott's avatar

People who make less than 134% of poverty have low voting propensity. This group is disproportionately black and female, who still vote 92-8D when they show up. Ergo, the people hurt by benefits cuts might not have much voting power

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Testing123's avatar

A plurality of Medicaid beneficiaries nationwide are white (roughly 43%), followed by hispanic. 54% are female. So sure, they are disproportionately black and female relative to the population, but black beneficiaries (not to mention black and female) make up a very small proportion of the overall enrollment. I'm not sure why you're explicitly focusing on them.

There are also waiver populations nationwide that make more than 134% of the FPL.

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David Abbott's avatar

you say black females constitute a “very small” percentage of medicaid recipients. i suggest you retract the “very”

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Testing123's avatar

Based off of what David? I included the statistics in my response. A) I said black beneficiaries make up a very small percentage- 20% of the Medicaid population is black. B) 54% of the population is female, so lets say 11-13% of the enrollment population is black and female. Do you disagree with characterizing 13% (or even 20%) of an overall population as making up a very small percentage of the total population?

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David Abbott's avatar

13% is not very small. When this group votes D 92-8, that 13% significantly impacts the overall elasticity of the electorate.

If 13% is very small, then blacks of both genders are a very small voting block. That’s not how people talk, you might get away with saying 13% is small. I might get away with calling 13% significant. In any event, 13% is material and 20% is clearly materiel.

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JPO's avatar

How much of this is due to most states having some cutesy name for Medicaid instead of calling it Medicaid?

"Oh, they're cutting Medicaid - good thing I've got [HuskyHealth/KanCare/MassHealth/MississippiCAN/ACCESSNebraska/SoonerCare/Healthy Connections/BadgerCare], so I'll be fine."

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Andrew S's avatar

Saying the Dems will screw it up ignores that people have been voting against their own material interests and for culture war BS for decades. You can’t just flip a switch overnight.

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Nathaniel L's avatar

But this kind of dismissive framing is part of the problem. What if instead we say that people have been affirmatively voting for their cultural interests for decades. When people tell you over and over that something is important to them, at some point, if you're looking to persuade, you should reevaluate your calculus.

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Joachim's avatar

To some extent I agree (Dems should move to the center on immigration, crime, guns and certain culture war issues). But when you think that your own economic situation is less important than making life hard for gay people, then maybe you deserve to be dismissed

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Nathaniel L's avatar

Well maybe you do, but what I'm trying to point out is the poverty of this "they're voting against their interests for BS reasons" line. The reasons aren't BS to the people motivated by them! In other contexts we think well of people who weight their principles more highly than naked appeals to their material self interest. It's a peculiar form of selective blindness that causes some liberals never to consider e.g. religious voters through that lens.

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Tom Hitchner's avatar

“Voting against their own interests” can be reductive, but I think we’ve overcorrected when we treat voters as fully rational and aware. “Keep your government hands off my Medicare,” blaming Biden for Roe being struck down…the truth is these are not smart guys, and things got out of hand.

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Andrew S's avatar

I posted about this elsewhere, but the spreads on these things in terms of public opinion aren’t massive. In a two-party system, you wouldn’t expect both parties to take the same position on an issue where the public is split like 55/45.

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Nathaniel L's avatar

That's fair, but speaking of issues that are split but with a clear lean, it would probably benefit the Democrats to start approaching some LGBT issues the way Trump approached abortion during the campaign.

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Daniel's avatar

I don’t think they care, and I also don’t think there are as many of them as you think. They don’t care because it’s already hard enough to convince people to get health insurance, and where this ends up is that poor people will still show up to the hospital ER without the ability to pay afterward. And there aren’t as many of these people voting Republican as you think because Republicans skew old and Medicare will still be there.

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Patrick MacDonald's avatar

I think one of the problems for democrats is they have not been able to effectively communicate this message. And by "effectively communicate" I don't mean just saying this repeatedly - I mean actually grabbing the attention of the people they are trying to speak to so they hear the message. Politicians giving a couple lines in a press conference is not effective communication. A few articles in the NYT is not effective communication. They need to try something different.

Of course this might not work - the people Democrats are trying to persuade might not be convinced or decide that their cultural grievances are more important. But at the moment I have a hard time determining whether this is actually a bad argument, or just one that is not being communicated effectively.

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Seneca Plutarchus's avatar

Probably Democrat constituencies.

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Tom Hitchner's avatar

*Democratic, please

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John E's avatar

I'm curious, if he had said "Dem constituencies" would that have bothered you?

Its odd to me that people dislike "Democrat" when the fiercest partisan I knew used that word to describe herself all the time.

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Tom Hitchner's avatar

"I'm curious, if he had said "Dem constituencies" would that have bothered you?"

Well, this is relevant to yesterday's post! "Dem" is just an abbreviation, but the use of "Democrat" as the adjective form was intentionally and explicitly coined as a sign of disrespect. So there's no using that one without giving offense, whether intentionally or not.

"Its odd to me that people dislike "Democrat" when the fiercest partisan I knew used that word to describe herself all the time."

As in, "I'm a Democrat"? I am also a Democrat. That's the noun form, not the adjective form. Some words are the same in both forms (like "Republican"!) and some aren't. Arbitrary, yes, but again, see yesterday's post: calling people by a new name to disrespect them is necessarily a disrespectful act.

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John E's avatar

Great connection to yesterday's post!

Perhaps what confuses me is how a word *you* accept and embrace as a description, can also be felt as disrespectful. It does feel arbitrary. Perhaps this is based on who we hear use the term and how that defines how we think about it. If you heard Rush Limbaugh or similar talking about "Democrats" then your hear disrespect now. If, as in my case, you hear someone talking about Republicans and saying "a Democrat would never do X (Nixon, cut healthcare, etc.) because of Democrat values" with a sense of pride, it feels different.

I'm probably sensitive about it because I see people accepting it as being disrespectful, as being disrespectful to her, because she would have never accepted that.

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Tom Hitchner's avatar

So, I think I wasn't clear about the noun/adjective distinction. There's nothing wrong with talking about "Democrats." That's the noun form and it's how members of the Democratic Party have been called forever, as far as I know.

What's objectionable is using "Democrat" as the adjective form, as in "Democrat voters" or "Democrat agenda." The name of the party is "The Democratic Party," so "Democratic" is the proper adjective form. "Democrat Party," "Democrat voters," "Democrat values"—these should all be "Democratic" per the official name. Using a shortened form of the name is a sign of disrespect, and has been understood that way for a long time: https://en.wikipedia.org/wiki/Democrat_Party_(epithet). (Did your friend use "Democrat" in this sense, not just as in "I'm a Democrat"? That would surprise me, but it would just show that some people are less fastidious than me, which isn't totally shocking.)

As a parallel, consider some people's habit of calling Matt Yglesias "Matty." There's nothing wrong with the name Matty. "Matty Groves" is the best Fairport Convention song. Matty Alou was a great baseball player. But Matt doesn't go by "Matty," he goes by Matt, and you'll find that people using the former name for him are without exception trying to express contempt.

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Casey's avatar

Related to fiscal policy and late breaking, but I would be shocked if it's legal for the president to unilaterally suspend all federal grants and loans. Who would have standing to contest? A recipient of said loans/grands? How would Congress be able to challenge - does a committee have to pass a resolution or does a single Congressperson have standing?

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Charles Ryder's avatar

He breaks a law a minute. IG firings require 30 days advance notice to Congress. The TikTok extension is also illegal: the law clearly says there can't be an extension unless the details of deal—including a qualified buyer who has been lined up—are in place.

The rule of law if for suckers.

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Marc Robbins's avatar

Can someone please explain Trump's "extension" of TikTok? As far as I can tell, you still can't download the app and isn't that what the law calls for (and *only* that)? At this moment, what has Trump done for TikTok that undercuts the law?

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James C.'s avatar

This is a good point. The law is about distributing or hosting the application itself but not the shared material on the application (by my reading).

> (1) Prohibition of foreign adversary controlled applications.—It shall be unlawful for an entity to distribute, maintain, or update (or enable the distribution, maintenance, or updating of) a foreign adversary controlled application by carrying out, within the land or maritime borders of the United States, any of the following:

(A) Providing services to distribute, maintain, or update such foreign adversary controlled application (including any source code of such application) by means of a marketplace (including an online mobile application store) through which users within the land or maritime borders of the United States may access, maintain, or update such application.

(B) Providing internet hosting services to enable the distribution, maintenance, or updating of such foreign adversary controlled application for users within the land or maritime borders of the United States.

https://www.govinfo.gov/content/pkg/COMPS-17758/uslm/COMPS-17758.xml

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Marc Robbins's avatar

Thanks. Aren't the platforms acting in accordance with the law?

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Charles Ryder's avatar

>At this moment, what has Trump done for TikTok that undercuts the law?<

Well, he issued an EO delaying the ban, in contrary to the plain language of the statute (there's no divestment deal ready to go).

Oracle and others consequently continue to facilitate the app's presence in the US (this includes ISPs).

For the record I was (and remain) highly skeptical of the law itself. But that's neither here nor there. The rule of law is paramount.

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Dan Quail's avatar

Any recipient. Any state where recipients are tax payers and this will materially affect their economies.

It stinks of a violation of basic contract law. You sign an agreement (the government) and have to honor it. Trump is acting like he IS the government and that he didn’t sign said contract and thus does not need to honor them, when in fact he is just the elected manager.

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Ethics Gradient's avatar

Am lawyer, am not your lawyer: yes, recipients would absolutely have standing.

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StonkyMcLawyer's avatar

But probably not until they’ve actually been denied something, and then they’ll have to prove their entitlement absent the EO. It’s gonna take many, many lawsuits.

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Gordon Blizzard's avatar

I mean, the war's already begun- Trump's decided to go ahead and stop federal grant disbursement, in a great effort to help West Virginia maintain its infrastructure. I'm sure with federal funds replaced with lib tears, all things can be done. This is exactly what the Founders wanted.

I sure hope you anti-woke people got what you wanted.

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TR's avatar

Whatever happens, they will never blame Trump, even if he comes in to personally promote it as the Trump Infrastructure and Trump Act, or the Trump Recovery and Urban-rural Major Project (TRUMP), and a motorcade of trucks with TRUMP written on them come to install giant banners with his face on them, hanging from every street light. It will either be the greatest thing ever, or "Thanks, Obama!"

For Trump loyalists, it's easier to teach pigs to fly and camels to walk through the eye of a needle than to shake their faith in their lord and savior.

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Kevin M.'s avatar

I think it's worth noting that studies show that recent Medicaid expansions have not led to actual better health outcomes.

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John from VA's avatar

That's likely not true. You're probably thinking of Finkelstein et al, which is an RCT, based on a Medicaid expansion. The study did not find significant mortality effects from expansion. The thing is, the study didn't cover enough for people for long enough to have enough statistical power to find the effect that other, more recent and bigger studies have shown

There's been a pretty extensive literature on Medicaid Expansion, and it generally points to real mortality effects and other benefits from expansion.

https://www.kff.org/report-section/building-on-the-evidence-base-studies-on-the-effects-of-medicaid-expansion-february-2020-to-march-2021-report/#:~:text=A%202020%20national%20study%20found,in%20health%20care%20amenable%20mortality.

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Kevin M.'s avatar

So the high-quality RCT trial shows no effect, and a swath of lower-quality studies show an effect. The bias of low-quality studies cannot be overcome just by grouping a bunch of them together.

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John from VA's avatar

No, the high quality RCT shows a reduction in mortality that isn't significant. That can mean that the effect is 0, or that her sample and treatment didn't have enough statistical power.

This is why we tell stat students that they reject or fail to reject the null hypothesis. You do not accept the null hypothesis. If this was all we had, we'd be uncertain, but it's not all we have.

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Matt A's avatar

Reduction in mortality, while being the most important endpoint, is also extremely noisy. (See here for a ton of information, much of which is germane to the conversation in this thread: https://www.astralcodexten.com/p/contra-hanson-on-medical-effectiveness)

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Dan Quail's avatar

The reason people use mortality is because of data availability. It’s a proxy.

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Dan Quail's avatar

The only time to accept a null hypothesis is when you get such a small error bar around zero that the effect is effectively zero even if it was statistically different from zero (in terms of magnitude.)

So many people don’t understand econometrics, thank you for the explaining it to some folks who misinterpret studies.

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Dan Quail's avatar

It isn’t a “high quality” RCT. It’s a short term study with low statistical power that gets oversold due to Harvard credentials of the authors.

If you want good work on Medicaid and the long term benefits look to Goodman-Bacon and Martha Bailey.

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Dan Quail's avatar

Amy Finklestein is a data thief. She stole data from a peer under false pretense and didn’t even give them back paper copies.

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Daniel's avatar

Health outcomes as a function of insurance coverage is a crazy game to play. The things that make someone healthy are far removed from the things that are expensive medical treatments. They include exercising, not being fat, and going to checkups to avoid serious problems down the line. By the time you’re at the hospital for that triple bypass surgery, it’s way too late to start improving your health outcomes except marginally.

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Dylan Vitt's avatar

I mean the point of health insurance isn’t necessarily better health outcomes, it’s less medical debt

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splendric the wise's avatar

This is a bit muddled by the fact that it is, as far as I understand, quite difficult to actually collect on medical debt specifically.

Obviously the technocrat in me prefers a system where universal coverage means no one gets crazy bills, vs. a system where people sometimes get crazy bills and promptly throw them away and then nothing happens, but it does seem like the real-world impact here would be limited.

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ML's avatar

They collect on a lot of it, and immiserate anyone unlucky enough to have assets and or a steady income. They just don't collect on it past a certain point. Plus the write-offs look worse than they are because they start with the notion that someone is charged the full listed cost for a procedure --- which no one actually pays and no one expects to ever receive.

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splendric the wise's avatar

Did you see the RCT where they tried buying up lots of medical debt and forgiving it?

https://www.nber.org/papers/w32315

Didn't show any positive outcome on any measures of interest, including no improvement in financial well-being. Do you know what's going on there? Underpowered?

My thinking was that people never pay the medical debts in any case, so forgiving them can't help.

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ML's avatar

I just read the abstract, may go back and read the rest.

Just as a first impression, they talk about tracking debt after it's been turned over to debt collectors. I'm not sure what that means exactly. Some hospital systems have their own collections department, and then turn debt over after those efforts are exhausted. So what they might be looking at is debt left over after they've gotten most of what's gettable.

Say you're a middle class person, maybe you have crappy insurance, or some other quirk or misfortune makes you fall outside of coverage that leaves you with a big bill, say in the tens of thousands of dollars. You're going to pay all that you can on that bill, foregoing lots of other things you'd otherwise spend your money on until you have spent down any assets you started with, and any discretionary income you might have had. You're going to stop saving for retirement, no college savings, defer maintenance on homes, cars, etc. Your real lifestyle goes down. That's the debt that gets collected.

If you have no or very little income or assets, kind of obviously you can't pay so you don't. That's what goes to debt collectors, so you're looking at a group of people who are impoverished already. We know that changing outcomes for those folks is difficult generally because the reasons for their impoverishment are multiple.

One last note, not specific to the study, but if you have outsized medical debt that usually means you or a family member was very sick for a long time. This usually means someone who had an income stream can't work anymore and that income is lost, and/or someone earning an income has to cut back drastically on work in order to care for the sick family member.

Back to the study, sort of. In countries where being sick does not also land you with a large unexpected debt, the whole draw down of assets and income never occurs. No one ever has to think, holy crap my wife/husband/kid just got a crappy diagnosis, and on top of everything else I'm going to move from middle class to poor. Those countries simply forgive the debt, or more accurately spread it over the population, before it even occurs.

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splendric the wise's avatar

Yeah, “We designed our hospital debt experiment to relieve debt at the moment it is sent to collections (15 months after the medical service on average) … It is possible that an earlier intervention may have been more effective.”

I’m just surprised there are so many hospitals that are that on the ball, they’re suing for debt and enforcing judgments in just 15 months.

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Eric C.'s avatar

I have a hard time squaring that with the number of people I know who have had to sell their stuff, or start a GoFundMe, or rack up credit card debt to pay their hospital bills. Similar to Matt's license plate article[1] I can't be in favor of a system where people that try to do the right thing and pay off their debt are punished, while people that throw up their hands and dare the hospital to collect it get to skate.

[1]https://www.slowboring.com/p/we-cant-tolerate-fake-expired-and

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Helikitty's avatar

Depends on where you are. In TN they will absolutely take you to court to have your wages garnished. I don’t think they can do that in WA.

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West of Eden's avatar

Lower reimbursement rates for Medicaid means fewer providers willing to accept it, means longer waits for services, means increased morbidity and mortality.

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MagellanNH's avatar

Is that the relevant metric though? Of course it's fair to push for the highest efficacy possible, but I'd call it a win as long as it reduces human suffering by a meaningful amount.

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Helikitty's avatar

So? It’s not about health outcomes.

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Daniel's avatar

I agree with everything Matt wrote here except the conclusion. This should be at the core of the Democratic Party. Unfortunately we are about to find out that opposing this war on poor people doesn’t motivate voters, doesn’t net out to votes, and won’t expand the tent. That said, I hope that Democrats find their way to opposing this anyway because it’s the right thing to do.

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