Man, that last question represents a scary outlook on life. Not a long journey from that (wholly incorrect) line of thinking to one that justifies or commits violence. I worry that Matt's response is about 6 grade levels of thinking higher than the questioner can understand.
I find that line of thinking in the question to be really disturbing. And I really dislike the politicians who think those who echo it are voicing fair concerns about the medical system.
It just seems like an abstract question to me. Like how we attribute USAID deaths to Elon Musk. I hold him fully responsible for that, but that doesn’t mean I condone his murder.
It’s sort of like EA people arguing over how much suffering is caused by the shrimping industry, or how many future people we’re effectively killing with climate change. That doesn’t translate to firebombing a seafood restaurant.
Agree. Matt’s commentary is fine but I wish he had clearly stated “as far as we know the number of deaths that can be reasonably attributed to Brian Thompson is zero.”
The price of living in a society is that even if you can drawn a jagged or even straight line between him and someone's death (probably possible with any powerful person), you don't support his murder. If his behavior is unacceptable, you change laws; if he breaks the law you punish him with the justice system. We don't get to be a country of individual judge, jury and executioner - nor should we cheer it on even if it seems right by some kind of wild accounting - because living in that country would be hell.
We do get to make moral judgments about people’s actions though. And if we’re making moral judgments about the actions of a healthcare CEO they should be based on a realistic assessment of the impact of the choices he made, not a blanket condemnation of his line of work.
I mean if we straight-up banned health insurance without instituting some form of universal care and just demanded everybody pay for everything out of pocket, almost certainly more people would die? So if we're going by this logic (which I don't buy), given the current state of law, he's saving lives.
I think the choice of counterfactual is important if you’re trying to attribute lives saved/lost because of a given insurance company CEO. are we saying the alternative is no insurance companies and a free market? No ins companies and NHS-style single payer? Brian Thompson being replaced with a CEO of a different ins company, or is he being replaced with some random guy off the street? All
Of those counterfactuals will yield different accounts of lives saved or lost. Without defining that it’s meaningless to ask the question of what Thompson is responsible for.
The best counterfactual is what should happen to the government bureaucrat that denies treatment under Universal Healthcare? Do you get to shoot them too? Because every government run healthcare system makes the exact same decisions that private health insurance companies make.
Here I'm defining the alternative as "status quo with no health insurance companies."
If there was a case made that Thompson was a uniquely stingy CEO, then replace him with another, but nobody's made that case. It's all "health insurance is immoral" effectively.
Yeah I was just piggybacking on your comment, not trying to push on your analysis in particular.
I think if you built a case that Thompson was negligent in his duties as CEO and cost lives and a better CEO would have done better, then you could have a case that he bears some moral responsibility for those deaths. But if the assertion is “if he/the system had been perfect those people would still be alive” is very dubious moral reasoning.
And why does this logic only apply to ins companies? Is there some bureaucrat or elected official in the UK who deserves to go to prison for blinding my friend’s grandmother because the NHS did not approve her macular degeneration treatments fast enough?
It's actually a bit more reasonable to be upset with the UK bureaucrat for doing a bad job because it is actually their job to make the decisions that save the most lives. Insurance companies are just there to make money. 🤷
I think the fairest accounting is that a healthcare CEO is both responsible for thousands of lives saved, and also for thousands of deaths. That's just the nature of being in a position of power and making hard choices.
I mean responsible in the sense that when a doctor amputates someone's leg, they are responsible for saving the patient's life, and they are also responsible for that person not having a leg anymore. A healthcare CEO is like 1/10,000th responsible for a billion healthcare decisions. There are going to be some wins and losses involved, and hopefully many many more wins than losses.
Your point is very reasonable. When decisions are made about airlines or traffic or pollution or any sort of very broad thing, there are a handful of people who will die because of the new policy and a handful who now won't die. But you may not even be able to determine the identity of *anyone* in either group. If 2500 people get cancer versus 2400 you can't identity the 100.
If we're lucky the total deaths go down. It's all trade-offs.
PEOPLE WILL DIE https://reason.com/video/2017/06/28/remy-people-will-die/ is so often a trump card on reasonable conversation, and a lot of people will do whatever they can to avoid being accused of wanting people to die. But people will die from either choice and we need to accept that.
…Or lives. They’re responsible for ensuring that the company operates effectively, deciding what gets covered and what doesn’t is not up to them individually, a lot of it is decided by government regulation or medical standards.
This times 1,000. People act like the CEO is responsible for the entire framework that the insurance company operates within. Health care is massively complicated. The outcomes people are talking about here are driven by thousands upon thousands of separate inputs in almost every instance. Saying one CEO is responsible for almost any specific health care outcome for any individual is absurd.
Does a healthcare CEO, or any CEO, really have that much power? Don't they have to operate within stockholder constraints, embedded company culture, and threat of being fired? (In other words, no one can control a massive system like an insurance agency.)
I am really partial to the idea that no one actually has agency, and we're all just hostage to our circumstances. Isaac Asimov called this idea Psychohistory. Leo Tolstoy devoted several chapters to the same idea in War and Peace. Jeff Goldblum talks about chaos theory in Jurassic Park. You can even see a variant of it in https://www.slowboring.com/p/even-meritocratic-systems-arent-fair.
On the other hand, believing that no one has any agency leads to apathy, and apathy is bad. My brain isn't big enough to be a Calvinist and acknowledge that none of my actions matter while still trying to do the right thing. So instead I just believe that people's actions matter and they are responsible for their decisions, even though it's technically not true.
I'll take leap of faith on personal agency: it's the systemic and collective that I've always been interested in. However, my starting question has been whether institutions can act morally. Thinking about it in terms of agency introduces a different angle for me.
What is the causal basis for attributing deaths to a healthcare CEO? It seems that any deaths attributable to his decisions would be from either saving money by denying coverage for expensive treatments or from making premiums so high that people are priced out of affording them. But he has to do one or the other, and it’s impossible to know ahead of time which would cause more deaths.
I get the point you're making, but compared to the counterfactual of "we still have no UHC, but insurance companies are banned" I can't figure out who that would be better for. The uninsured would still be uninsured. I guess healthy people would save a few bucks on healthcare premiums. Maybe some guy who gets mugged would survive in this alternate scenario.
"GIMME $100!"
"Dammit I just paid my healthcare premiums! I'm out!"
Brian Thompson in this case is being used as a stand in for "insurance companies refusing coverage," I think. And the difficulty here is:
a. Some coverage should be refused because it's snake oil or fraudulent or unnecessary. Replace insurance companies with incorruptible angels and those refusals will still happen, and also these refusals make the world a better place.
b. Some coverage is refused strategically by insurance companies--they should not refuse it but do so in hopes that the patients will just pay out of pocket or do something cheaper. This is bad and we want less of it.
c. Some coverage is refused because it is very expensive relative to its benefit. This is probably the right choice (medical care has limited resources like everything else), but is a bad thing--we wish we had more resources and could cover anything useful.
You might judge a CEO or insurance company as bad for doing too much (b), but it is often hard to distinguish that from (a) and (c), and the lines between the categories are fuzzy.
Has anyone credibly asserted that under Thompson’s leadership UHG was doing an inappropriate amount of (b) that led to deaths? Even Mangione didn’t really seem to have a specific complaint with him.
I think John Roberts has spoken of limiting liability somewhere between the want of a horseshoe nail and the loss of the kingdom and this applies to Bryan Thompson as well
I would expect that for any large insurer, Medicare included, you can find examples of ill people who died after being denied coverage for a treatment they thought might cure them, but that their insurer determined was experimental or of unproven efficacy or otherwise a waste of money.
The frontiers of medical technology are always changing and that means there will always be arguments at the edges over which specific treatments are considered standard and essential, vs extra, elective, experimental, or otherwise justifiably not part of the standard package. Today's experimental treatment might be tomorrow's essential care, or not.
The question is how and by whom should those decisions be made? Medical providers have expertise, but also have a conflict of interest, in that they're inclined to err on the side of paying themselves more. Nonmedical finance type overseers have their own conflicts, etc.
Slight caveat, I think most people who work for health insurance companies do probably think if themselves as doing something positive, and per my other comments, I think on net they are, but "provide medically necessary treatment to the best of your knowledge at the time" isn't QUITE the incentive medical insurance companies have. Unless directly prompted by the government, medical insurance is kind of indirectly a consumer product. It will cater to what consumers want and are willing and able to pay premius for (or rather, what their employer is usually), which is not always the same thing as medically necessary.
Agree, except would say that the term "medical necessity" should be understood as not so much a medical technical term of art, but as a commercial term -- what package of treatments do customers in the market for health insurance generally expect to be included standard, and what can feasibly be included without driving the price so high that nobody wants to buy the policy. In France, apparently, a nice stay at a thermal spa can be considered medically necessary, i.e., part of the standard package of medical treatments that people expect to have access to.
If you’re in the business of making life-or-death decisions, then almost surely you’ll be making some decisions that cause people to die and others that cause people to live, and very often one decision is going to cause both. You can be doing net good for the world even if there are people who die because of your decisions who wouldn’t have otherwise.
With a medical insurance claims adjuster, it’s probably single digits of lives, and with a medical insurance executive it’s probably in the hundreds of lives, but if you’re a legislator it’s probably in the thousands of lives, and sometimes tens or hundreds of thousands when you’re looking at air pollution legislation or car safety or the like.
The funny thing is, if I'm coming across here as a defender of the American healthcare system, I'm really not. I'm just defining the roles here. The job of an insurance claims adjuster is to pay out as little as possible while still providing the minimum amount of coverage that people are still willing to pay premiums for. Their incentive is not to save lives. I'm not upset with them about that, they're doing their jobs. But it's also true that the existence of the insurance industry pretty obviously saved thousands of lives, even as imperfect as it is if the alternative were just "no insurance" which the Luigi defenders seem to be implying would be preferable.
I remember a great Cautionary Tales podcast about this issue (it's been a while, so I'm almost certainly about to get some details wrong, so I apologize in advance). A man in England lobbied tirelessly o receive an experimental treatment that was denied by the NHS as being too costly and not likely to be effective. He thought it would save his life and he portrayed the NHS as bean-pushers and spreadsheet slaves who couldn't understand the importance of just approving this treatment and saving him. My recollection is eventually the public outcry led to changes that allowed him to get the treatment, and that it essentially made no difference and he died anyways.
The effectiveness of changes implemented to the NHS to cover the costs of these experimental treatments is, as I understand it, highly contested at best, with significant reasons to be skeptical that it's done anything other than drive up costs while providing little to no benefit to patients. It's just true that wishful thinking is pervasive within the patient community, and doctors who get paid for it are not highly incentivized to discourage such attitudes. It therefore often falls on number-crunchers to actually analyze the data and determine if a treatment is cost effective and reasonable to pursue.
The notion that it's greedy insurance companies that are causing the health and wellbeing of Americans to suffer seems wrong to me, but the uninformed will always find them to be an easy target of their ire. It's very unfortunate, especially when such attitudes literally result in a husband and father being gunned down on the streets.
I'm extremely sympathetic to the sick people fighting for any chance, even a slim chance, if it means they could get better, but the system as a whole cannot operate from the perspective of individual patients.
I think most other systems do a better job of hiding the technocrat making yes/no decisions on coverage. If you're a doctor and you know X isn't paid for in your country, you tell the patient there's nothing to do, and everyone goes on with their lives [1]. Knowing that X exists and is being *denied* to you is much worse. (Even if X would, in the end, have negative outcomes for you regardless of cost.)
I will just add that denying some of these unproven or experimental treatments may be in the patient's best interest. Avastin was conditionally approved for metastatic breast cancer in the US based on an increase in progression-free survival. The UK refused to do so and was accused of murdering breast cancer patients. When the more comprehensive studies were done, Avastin did not prolong life. It was associated with a much higher rate of adverse effects and women had fewer "good quality" days of life. I can't remember if it ended up decreasing the survival time. It's now no longer approved for metastatic breast cancer in the US.
There was also the scandal of women with metastatic Breast cancer undergoing high dose chemotherapy followed by autologous bone marrow transplant. It was a huge to do about insurers not covering it because it was experimental so we finally did a study and it turned out it wasn't effective and one of the earlier studies showing a benefit was faked.
I think in this specific case the questioner is on solid ground. Thompson isn’t just any healthcare executive and UHC isn’t just any insurance company.
UHC’s claim denials and shrinking coverage were, well, skyrocketing and we have pretty good evidence they were committing Medicare advantage fraud (see the wsj series on Medicare advantage). They are, or were, a criminal enterprise and the decisions that drove them there were made by executives, one of whom was brian Thompson.
No one at UHC was going to go to jail. We’re probably talking about a settlement at the DOJ. And, frankly? That’s not just nor a deterrent to it happening again. We shouldn’t be surprised someone did something extra legal. And we need to change the laws and ways in which we prosecute crimes in this country so that people who commit this kind of fraud go to prison.
I don't think this is responsive to the question, which is how many deaths was the CEO responsible for.
There is no "deny fewer claims but only the ones that will save lives, not the speculative expensive ones that don't help" policy lever. To a first approximation, there is only a "deny fewer claims" lever, which mechanically raises prices or reduces insurance coverage, and causes more deaths.
By all means, prosecute fraudulent healthcare executives instead of electing them to the Senate. But the question was on the potential justifiability of the murder of the CEO, and the idea that "the questioner was on solid ground" is the road to anarchy.
It would be one thing if UHC had done that. We’re not talking about marginal experimental treatments here.
UHC engaged in a willful strategy of pulling back coverage (abusing firm lock in), and abusing the prior auth system (ask any doctor about who suddenly became the worst HMO to deal with like magic 3-4 years ago) to cut costs and engaging in Medicare advantage fraud. When you suddenly require a prior auth for generics and make every doctor do 3-4 peer to peers by default, people are going to have questions.
Brian Thompson, and the executive team, should have gotten 25 to life if they willfully engaged in this strategy.
"(ask any doctor about who suddenly became the worst HMO to deal with like magic 3-4 years ago)"
Having seen how much the same procedure might be charged in Europe and the US, I very HIGHLY doubt that the insurers rather than the doctors are the guys who make healthcare less accessible here. Sure, Americans earn more than Germans on average, but American doctors earn MUCH more than German doctors on average. Still, I do NOT believe that people should think "My dear doctor, you want your annual income to be how high??? I will murder you.".
That sounds reasonable. I would expect British salaries to be above the EU average. But yeah, if the insurance company denying claims is responsible for people dying, what are the doctors who ask for American salaries responsible for?
I was not suggesting that his murder would be justifiable if the answer were high. I was suggesting that the people who actually do justify the murder are doubly wrong: first because murder is wrong no matter what someone has done and second because Thompson hadn’t done anything that could justify his murder even if you disagree with the first point.
The question is challenging because of course anyone being murdered is wrong. It's really hard to have a needed conversation on prior Authorizations and the big insurance problem. Might be a good evening review for Halina.
I doubt whether the Medicare Advantage fraud killed people; the decision to deny a much larger fraction of claims than competitors probably did, but it’s hard to say how many. I am curious if you have any idea what the corporate thinking was there, though—like Matt said, you can only get your medical loss ratio so low before you have to start rebating premiums, so “collect money for insurance and never pay anything out” has some real limitations as a strategy. So was it an epiphenomenon of trying to get the overhead/combined ratio as low as possible? Did UHC decide that “no coverage and maximum rebates” was the ideal way to take advantage of the principal-agent problems that come from America’s ridiculous employer-provided insurance system? Did a fortune teller tell Brian Thompson he wouldn’t see any legal or financial consequences for doing this and he said “YOLO”?
"you can only get your medical loss ratio so low before you have to start rebating premiums"
Rebating premiums isn't the only way to get your medical loss ratio down, as an ACA-regulated insurance company. You can also buy up a brunch of healthcare providers -- physician practices, pharmacies, etc -- and then steer your insured patients to them, and have them charge your insurance arm higher prices so that you capture the money on the other side. The left hand pays the right hand, and the medical loss ratio stays where it needs to be.
Without seeing UHC docs we’ll never know. It’s been received knowledge since the 80s that basically all insurance is run by idiots who can’t model out second order effects, and yes are that stupid.
The finance industry is only discovering that in the past decade, after economists discovered this a year before that. Insurance job talks are fun because it’s always “I know it looks dumb! I know! Are they stupid?!.” Most often this is LTC and life where you can get data, but my work with pharma with data that will never come out suggests it generalizes.
This all goes back to the FTC being banned from looking at any insurance after discovering a lot of annuities were scams.
Agreed. I think it is a reasonable question, as UHC's claims and denials were about double the industry average, and a good-faith answer would take this into account. The real question is whether there is a marginal increase in unnecessary deaths due to claims being denied. From there, you could logic out how many claims were being unfairly denied by UHC and come up with a number. I'm not an expert, so the answer may be zero, and it may be more than zero, but it is a reasonable question ot ask.
I don't think any answer to this question justifies vigilantes gunning down people on the street. I also don't think it is satisfying to just shrug, say it is an unknowable system, and walk away.
If a hard hat were purposely designed to fail industry standards twice as often as a cost-saving measure and the results were clearly borne out in statistics, wouldn't you expect there to be consequences?
There is no possible way that UHC claims and denials were double the industry average. Wherever that number came from, it should be debunked. And besides most “denials” in insurance are incorrect codes that are later corrected and paid out. Less than 1% of claims are in the end denied. Hospitals love to game the system and code for things that didn’t happen or pay more. Likely UHC is just better at catching those instances.
The strangest thing about all this is the real “murderers” are the doctors and hospitals who refuse to administer lifesaving treatment unless they can be more reasonably be assured they will get paid. A bit odd to blame a health insurance exec for a hospital going “sorry, I could save your life, but I need to eat too”. This is obviously hyperbole, but a hyperbole that makes more sense than blaming health insurance companies who simply pass on higher costs through premiums. It’s really no skin off their backs to collectively ok every treatment if they keep their medical loss ratio stable. Ironically, while this has been going on health insurance companies had the highest medical loss in the post Obamacare era.
Having worked in the insurance industry, you are correct about the denials. There are a lot of denials that occur because the claim is not billed correctly. Codes that should be bundled are submitted non-bundled. Then there are the claims that are submitted too late. Some error caused a provider to miss a bunch of services when they were sending claims and now it's too late. I constantly see articles on how terrible an insurance company is for not paying some patient's claim and it turns out that the provider billed it incorrectly, in some cases in ways that would be considered fraud if it was sent to medicare, and yet it's the fault of the insurance company not th provider who didn't bill correctly.
To start with, there is no source for the chart and the author doesn’t even know if it’s legit. As far as I can tell the only info available is for healthcare.gov which is what, 2% maybe 3% of the total marketplace and where this chart info comes from most likely.
And do we really think over 30% of claims are being denied? That’s total nonsense. I have a bunch of kids, many family members and I’ve never even heard of a denial beyond some dumb mistake that the doc or the insurance company fixed. What matters is real denials in terms of damn, that seems like it should be covered and they are straight out saying no. Those are very rare and probably most often admin errors. The ones that aren’t errors are edge cases where insurance says hell no we aren’t covering this because we aren’t sure it works and it will drive costs up and profits down. I don’t blame docs and patients for trying but you really want someone in the loop saying no.
For instance the story going around was Luigi got denied for a back surgery for spondylolisthesis which, the evidence shows, is not something surgery helps with. Still doctors recommend it especially in certain parts of the country. Should insurance deny it. Yep, probably.
Almost every insurer on that chart is above the industry average.
I'm really curious which insurers are bringing that down?
Kaiser brings it down some, but Kaiser is specifically an HMO that does treatment & insurance - they're not going to get many "wrong coded" claims. (The article also covers this)
ACA data- the source for that chart- is at 33%. UHC claims that’s “unfair” and gives us their own number. I dunno, I’m not disposed to think of UHC as reliable narrators here, or at least much less reliable than government data.
> Wherever that number came from, it should be debunked
I'm pretty sure Noah Smith wrote about this, or at least some other big substacker, and the IIRC the answer was exactly as you say below -- this number came from *nowhere at all*. It's flagrantly made up.
“doctors and hospitals who refuse to administer lifesaving treatment unless they can be more reasonably be assured they will get paid.”
Doctors in hospital settings have zero idea what your insurance is or whether you’re insured at all. That’s not their purview. They’re salaried, so they get paid regardless of whether you’re insured or not. They are not denying lifesaving treatments based on whether you can pay. If anything, they’re far too oblivious to whether patients can afford their recommended tests and treatments.
Hospitals are a different story, but they’re not allowed to deny emergency treatments. They also get stiffed on a a huge proportion of their bills, so if they’re trying to weed out who can pay, they aren’t doing a great job of it.
UHCs Prior auth and peer to peer practices got so bad John’s Hopkins walked away from them. Just refused to negotiate.
There’s a lot of saber rattling during these negotiations but never have I seen that. UHC was making people to peer to peers for almost everything- for my wife, a hematologist, it was for generics and clotting factor that’s been around since the 90s. For our oncologist friends, it was basic chemo. For our friend in anesthesiology, they were denying stuff after operations. Like, Hopkins will deal because they eat bitterness. They are assholes wrapped in an asshole flavored pastry, they love to fight. But these denials are probably killing people in other areas (deadweight loss, waiting for care) in oncology alone.
Tough chance of that when we have Mr. Pardon 4 Bribes in the White House. The only way we are getting more prosecutions is if it can somehow be turned into a financial benefit of Trump.
Was Luigi Mangione even aware of the accusations of Medicare fraud?
A basic rule of parenting or management or any kind of negative consequence is that there needs to be a connection between the crime and the punishment. No other health executive CEO is going to worry about being murdered because they commit Medicare fraud. They'll probably start taking a private car everywhere, though, instead of walking on the street and using public transportation like we want our elites to do.
I can tell you that after this all happened, UHC decided to deny coverage retroactively to someone I know, after over half a year and 300k of cancer therapy, after having previously approved all the care. They claimed that this person was eligible for Medicare.
Of course, they could have denied the coverage before that work was done, or just simply not approved all this work that they gave pre-approval for. That would have given her the ability to sign of for Medicare in time.
But instead, they decided to put someone who was covered by their insurance, going through chemotherapy, on the hook for 300k.
Of course, political violence is NEVER okay, and neither is glorification of terrorism.
But, on a completely separate note, UHC is a particularly bad actor.
What your friend went through is terrible, but the blame doesn't (solely) lie with UHC. Medicare coverage starts at age 65, and your friend should have received notification. I believe they should have still been able to apply for Medicare and cover up to six months of past charges (if Google is to be believed).
I think there's a common assumption that denials juice insurance companies' profits. But with the medical loss ratio being a minimum of 85% for large insurers, I assume they are all operating right at the edge of this (I remember getting a check once in 2012 when my insurer underestimated). Why do we not put some of the blame on the greedy doctors requesting more and more unjustified medical care?
A claims denial leading to death is the exception, not the rule. There is no sound case for violence being justified here.
Having gone from BCBS to UHC and back to BCBS in the last 5 years, I can way that UHC was significantly harder to deal with and seemed to deny claims without justification.
I'd like a law mandating that all insurers disclose the % of successful appeals annually. That would show who is denying care inappropriately. A Kaiser Foundation study found that, in medicare advantage plans, the highest rates of successful appeals occurred with Centene, CVS, and UHC. Other than Kaiser, appeals were successful between 70% to 94% of the time, indicating that many claims denials are inappropriate (although this is influenced by selection bias as only the most justified denials get appealed).
Interestingly, the appeal rate (% appealed) was inversely correlated with the number of prior authorizations required per enrollee. UHC had a low PA rate, but high appeal and success appeal rates. Hard to know how much of the PA rate was policy versus mix of patients.
Yeah, this is a very dangerous road to say someone can be killed by extrajudicial means because of 2nd, 3rd or 4th order effects. And I say this as someone who thinks that Brian Johnson can be reasonably called a particularly loathsome CEO even compared to other Health Care executive CEO for reasons laid out by the commentator "Jimmy Hoffa". In general I think the bar needs to be extremely high for extrajudicial killing to be justified; it's one of the reasons I have huge issues with "Stand your Ground" laws (at least as written). But if you can kill someone under the idea that "due to second, third, fourth order effects" you're responsible for someone's death, then basically all of us can be justified to be killed by climate activists under the idea we all contribute to global warming and global warming has very likely killed thousands of people.
First, global warming is obviously going to kill many orders of magnitude more than thousands of people. Second, the relevant question from the standpoint of trying to justify the CEO's murder (or polluters' for that matter) is whether the one killing will save many future lives. It's not hard to find hypotheticals that accomplish this (e.g., baby Hitler examples), and it does not matter logically that the effects are distant from the cause. The difficulty with the question is that it supposes there is a justification for past deaths (not clear if this is meant as a moral or a legal justification), which the CEO murder obviously cannot prevent.
I have had insurance with three different companies now, and UHC is far and away the worst. I have had nothing but extremely negative experiences with them all around in pretty much every arena possible, from the website having inaccurate information, terrible customer service, and all the way to *several* unjustified denials (later reversed but only after I spent hours fighting with various people on the phone). I am strongly considering leaving my employer and no joke the #1 thing I will ask about benefits before accepting future job offers will be who the insurance provider is, and you'd have to pay me a hell of a lot of money to ever put up with another UHC plan.
But at the end of the day, extrajudicial murders are, in fact, bad. Even if the company was somehow 100x more evil to the point that it might justify some kind of criminality, 'assassinating the CEO' is simultaneously one of the least moral *and* least effective acts of political terror you could commit. If we are suddenly justifying killing people for providing a poor product relative to market competitors I feel like one could come up with quite a few guys that should be higher up on the list.
To be clear, I have been arguing with people justifying Thompson’s murder for almost a year now on the basis that murder is wrong, but it only just occurred to me to challenge the underlying assumption that his management decisions led to many people’s death. I asked the question to ensure that I would have a reasonably strong factual basis for making that argument.
Interesting, but I think the better question is whether the CEO's murder can be morally justified on the ground that it avoided future deaths by ending that CEO's policies or practices that would have caused future deaths, and/or convincing other insurers to change their policies or practices that would have caused future deaths. If either of these suppositions were true and could be proven, it would provide a sound utilitarian moral justification for the murder. But neither past deaths nor avoided future deaths can provide a sound legal justification for the murder. Past deaths can't be used as a ground for the "defense of others", and the link between CEO-driven policies and possible future deaths caused by those policies is too tenuous to fit the requirements for that defense (remote in time and place, etc.)
Not to mention there is precisely zero reason to believe that the system that gave us the CEO that was murdered won't simply replace him with another CEO that will have the same motivations and lead to the same or similar outcomes.
I think that Mangione is a monster and I want him to rot in jail the rest of his life, and the people who support him are also horrific human beings. But even if you agree that they're right about how awful the CEO was, his action is still horrific and useless based on the fact that it doesn't address any of the causes of the things he claims to care about.
I agree that there is no reason to believe the CEO's murder saved any other lives. Mangione seems mentally disturbed and morally confused, so that at least makes him very dangerous, if not "a monster"
A technicality I would dispute. Someone's mental disturbances and moral confusion may be the reason they are, in fact, a monster. Shooting a husband and father in cold blood because your politics and morals are ass-backwards is not incompatible with being a monster.
Right, but "monster" implies an involuntary and immutable state of being. I don't know that much about Mangione, but if he got the right meds and that allowed him to realize that his actions were gravely wrong, then he would cease to be a "monster".
When people are talking about moral desert, they’re concerned with the moral character of a person’s past actions, not necessarily what harm ought to be visited upon a person. It’s perfectly sensible to have a discussion about the former distinct from the latter.
Discussing moral desert for past actions is really just time-traveling the hypothetical to a point in time prior to the past actions. It asks "should he have done the thing" that caused the harm that could have been prevented if he hadn't done the thing, or "should he have been prevented from doing" the thing he did that caused the past harm. So the analysis is exactly the same: if preventing the past action would have prevented the (greater) harm the action caused, then there would have been a sound utilitarian basis for preventing it.
It's not really "scary", it's just straight-up utilitarian logic: if killing one CEO will prevent more than one future death by avoiding lethal denials of coverage, the action is net beneficial. The factual premises are almost certainly wrong -- including the assumption that the current CEO has anything to do with coverage denials, or that the next CEO will deny coverage less, but the "outlook" is one that takes life-saving seriously, in the grand tradition of a million utilitarian thought experiments.
Utilitarianism IS a system of moral reasoning, and may be the most intellectually defensible one among the available candidates. Far more so than religious doctrines or deontological systems, many of which ultimately resolve into utilitarian / consequentialist assumptions on further inspection.
It just tends to lead us in places the monkey brain finds uncomfortable or at least quite strange (Bentham's Bulldog being even weirder than Jeremy Bentham himself).
I agree that most of the time most people would prefer to act like monkeys than to think deeply about what they are doing. It's a long-standing problem for the discipline of philosophy as a whole.
I feel like we all read two different questions. How are you guys reacting this way? Did you read the question? The questioner is obviously not taking this position, he's offering up the logic for Matt to attack it. I think that's kind of a lame sort of question to ask (this place has enough left-bashing as is without poking Matt to do more of it by posing an argument you don't even believe in), but if you read the text of the question I think it's fairly obvious the questioner does not, in fact, support the assassination of Brian Thompson.
He clearly does not support the murder and thinks that line of justification is very dubious. I’m gonna assume people here just hadn’t had their morning coffee.
It wasn’t about offering up the logic for attack, it was about gathering information about the factual premises. Boiled to its essence the question is “how often does an insurance company’s denial of coverage actually lead to death in a given year, and was UHC on the high end of this range?”
If the actual answer was “less than you’d think but probably at least a few hundred”, I wouldn’t raise this point when people try to argue that Thompson’s murder was justified. If the answer was “none” then I would.
Sometimes I wonder if some of these questions are designed to get Matt to write things that allow his critics to bash him from the left. They want some quote so they can say “Matt Yglesias thinks it’s cool that insurance companies deny people coverage, even if they die because of it.” I also wonder if Matt, aware of this, writes responses like today’s in order to deny them an easy quote.
Absolutely. Who lionizes Thomas Matthew Crooks, or indeed remembers him at all except for "what if Luigi was ugly" comments like this? Justified or not, what he tried to do was a lot higher-stakes than what Luigi did.
I have seen people claim that Brian Thompson “killed millions of people” and it never occurs to them as to how this can be true in a country with 3 million total deaths a year.
These people are just lazy epistemological nihilists who want to revel in violence and evil.
I think we are currently going through like the fifth broad systemic transformation of capitalism since it was originally dubbed 'late stage capitalism'.
Especially when you consider how big a deal Covid was and that caused over a million deaths in the US. If a single insurance company was causing genocide-level death in this country, it would be pretty obvious.
Hah, this morning I was thinking that “how much is a million anyway?” is a reason specifically *not* to switch to metric.
Quick quiz question - without calculating, do you have any sense whether a megasecond is more or less than a year?
Being able to say that something is a megawatt or a megajoule makes it *sound* like you know how much it is, but it doesn’t give you the understanding you actually have if there’s a natural unit in the vicinity. You can understand how long a duration is if you measure it in years or days or seconds, but if you insist on measuring it in seconds and kiloseconds and megaseconds, you don’t really understand how long it is (though you can easily calculate some ratios).
Quiz answer: an hour is 3600 seconds, so a megasecond is just under 300 hours, which is about two weeks.
I've noticed this effect with metric usage outside of scientific settings. Metric users frequently throw away the useful prefixes of metric by saying things like "2,500 kilometers" to stick with a familiar unit rather than "2.5 megameters." "Tonne" is a particularly hideous example.
iirc my original proposal was purely in terms of money. We were all discussing how hard it is to wrap our heads around trillions of dollars or something like that. imo we'd run into problems with very large numbers of any kind because we're just up-jumped monkeys with all the cognitive setbacks that entails.
To be fair(?), there's very likely a large overlap in the circle of people who believe Brian Thompson “killed millions of people” and the circle of people who believe American law enforcement kill 10,000+ unarmed black men each year.
And they want everyone to think they are somehow morally superior because they can repeat lazy nonsensical fictions too. Especially when they are advocating for… wanton acts of violence.
He was CEO for 3 years and worked at UHC in other executive roles for almost 17 years before that. If he started his killing spree as soon as he joined UHC in 2004, and "millions of people" means at least 1M, then he would have had to have been responsible for 1M deaths out of the 32M deaths that occurred in the US between 2004 and 2023, or 3.1% of all deaths.
But this good news is just in from Chat GPT 4.o mini in response to the question "when was Brian Thompson killed?":
"As of now, Brian Thompson has not passed away. He is currently serving as the CEO UnitedHealthCare. If you have any specific context or event in mind regarding him, please share!"
1) I don't know how to break it to mini;
2) I am so grateful we are maintaining our AI lead over China....
4o mini??? i honestly didn't realize models that old were still available to use. that's like an 18 month old model! in AI time that's practically a century
Im curious how many people ACTUALLY think that. This seems, to me, like an online thing that maybe 1000 people believe in the whole country that got blown out of proportion due to the internet
The voters' preferences on corruption would lead to an even lower-quality professional political class than we have today. The sample wants robots that are willing to submit timecards, take drug tests, and do "what most people want", even though in the aggregate the public's policy preferences are incoherent. At a deep level we seem to have the quality of government we deserve.
Taking drug tests honestly doesn’t seem unreasonable to me. Lots of well compensated career professionals are subject to drug tests (military officers, pilots, etc). If the compensation is appropriate, additional oversight won’t deter quality candidates. The real problem is we can’t raise compensation (or at least our representatives believe they’ll be penalized for raising compensation)
I'm trying to figure out how this would work in practice. Presidential candidates used to release their tax returns, and then Trump didn't, and nothing happened. Would drug tests work the same way?
If a politician tests positive for drug use, what happens? Is it purely informational for the voters? Would they be expelled by their relevant legislative body? Would refusal to take the test result in expulsion?
Great question, you beat me to it while I was typing the same thing. There's also ratfucking opportunity there in trying to spike a test of members of the opposition.
Don’t let them file to run again if they refuse to take a random drug test as administered by an independent agency. I don’t think they should be immediately fired for pissing hot, but it seems fair to provide the results to the public to evaluate in the voting booth. If they’re happy with the results from their cocaine snorting representative, that’s fine.
We should make submitting your taxes a requirement to file too while we’re at it; the problem was that was never actually a law, just a norm.
Informational - you can't add random qualifying pre-conditions to the bare Constitutional requirements for office holding (unless you amend the Constitution). Article 1 does allow each chamber of the Congress to expel members for "disorderly conduct", but it requires a 2/3 vote of the body for removal, so removal for drug use could not be made an "automatic" sanction without (another) Constitutional amendement.
We write a law that forces politicians to take drug tests and removes them from office if they fail or refuse. Same thing we would do for any politician we discover has committed a crime.
My last two desk jobs required drug testing prior to hiring, it's pretty common in manufacturing.
I would only support drug testing legislators to have them go to the same facility I did just outside the Beltway in Maryland, so they could sit in the same waiting area I did for an hour among a segment of the population they really never interact with. Let them deal with a jaded staff that has seen every way to cheat the test, and applied policies to prevent it, or just have to take time out of a busy day to do this, and maybe lawmakers will think twice before suggesting drug testing as a benefits requirement or legal punishment.
Forcing people to use the systems they run once in a while is valuable. But drug testing politicians for the sake of the drug testing isn’t very valuable.
There’s some historical evidence to suggest Richard Nixon was drunk while weighing the decision to launch a nuclear strike against North Korea following their attack on a US reconnaissance plane in 1969. If true, I for one would have liked that information to be public knowledge during the 1972 campaign.
Churchill was frequently drunk throughout WWII. And he was brilliant.
So the fuck what.
Prissy teetotalism is sterile. (and no I am not a drinker myself)
This leaving aside entirely the utter uselessness of scheduled tests to detect something like what you cite - unless you ahve the fucking sobriety tests all the fucking time as if they're going through DWI checkpoints
You don't have them all the time and you have them scheduled well in advance. Can people get around that by just being sober for three days before the test? Absolutely! That's the point. You're screening for people who can't even do that.
Sucking up to donors is way more humiliating than peeing in a cup. It's weird that this is a hill people are willing to die on.
It's just an obviously stupid idea, a waste of time and resources and serving no function beyond generally prudishness.
Bad idiotic "reforms" layering on more requirements, more bureaucracy, more procedures is half of what got the Left into the idiotic bind it is in, along with prissy secular moralising.
(and do read for detail - "detect something like what you cite"- i.e. Nixon supposedly being intoxicated while deciding on N. Korea)
We have had three self-proclaimed straight-edge Presidents in recent history: Bush 2, Biden and Trump. I too think it's important to know which candidates have the mental fortitude to handle their booze.
Before one of the debates, we really should ask presidential candidates to get liquored up to a BAC of .12 so we can see how they function when they’re right in the slot
I'm back at the assumption that they would perform better sober than high -- not at all clear to me. Opinion may be based on the public's annoyance that they have to take drug tests for many jobs but legislators don't. But in that case, the starting point may be the application of any health, safety and non-discrimination laws which don't apply to Congress.
Those are careers where you are doing physical labor that requires a high level of coordination which could be impaired by drugs, it would be silly to require drug tests for a high-level desk job like politician.
There are a lot of desk jockeys in the military taking drug tests. We test them (at least in part) because they’re responsible for making life or death decisions, not because of the physical requirements of the job.
We test them primarily because there's no appetite for distinguishing between roles where it matters or doesn't matter, and drug testing in the military itself is mostly an artifact of a different era and view about the war on drugs.
People in the military have agreed to a lot more loss of privacy and individual liberty than pretty much anyone else. In what other job can your boss order you to do something that will get you killed and then have you executed if you refuse?
There’s a strong argument that that level of discipline is necessary for the military. If you want to make a comparable argument for politicians, go ahead, but do it on its own merits, not by comparison to the military.
If the point was ensuring they’re not on drugs at work, then it should be random on-the-spot drug tests. What’s the point in learning that someone in one of these jobs sometimes takes a drink or gets high on a Friday night?
Nor can you tell if they do cocaine on a Friday night! Drug tests are good at telling if someone *ever* does cannabis, and good at telling if someone is *currently* on alcohol or cocaine, but it's not clear what connection they have to job functions under any of the ways they are usually used.
Test for what drugs? Given the age of so many members of congress, I assume a large percentage of them are taking about half a pharmacy rack on any given day.
Making the job of being a congressperson painful selects for zealots and rich guys. The zealots don't care if their life sucks, and the rich guys can pay to make their life not suck.
Taking a drug test is not painful. These people are inherently public figures and will have their life inspected from every angle; a drug test is not substantially more invasive than having journalists comb through your digital footprint for the comments you’ve left on porn sites. I agree, we should compensate congressional representatives to the same degree we compensate senior managers in private industry at least. But public scrutiny is part of the job
Pilots are drug tested, as are other DOT regulated transportation employees, because drugs directly endanger the public and directly the nature of their ability to perform the functions of their job.
So, no, I don’t think this is a fair comparison. Drug testing politicians is not about the nature of their work, and it is extremely unclear that drugs are at all pervasive among politicians or have any meaningful effect on their performance or the public’s safety.
Drug testing people is just a dumb voter reactionary position.
How do we factor in "this guy is a raging alcoholic"? Not a serving politician per se, but evidence points towards our SecDef having fallen off the wagon if he's ever been on it.
Bad representatives should be voted out regardless of whether they’re using drugs. Good representatives should be reelected regardless of whether they’re using drugs. If you need the test to tell you whether they’re on drugs, they’re doing fine.
Yes, and they do so related to the performance of their jobs. FDR for example could not pass a physical yet he appears to have an extremely capable politician.
That was my aim. They have specific tests that we do for their jobs. Notably, the tests are not the same between them. I don't think we have an idea of how to test for capable politician.
there also seems to be a lot of people here that believe standard drug tests are real. they’re not. most places can test for marijuana and even that is limited. what do people think is possible here?
You're trying to solve a problem that doesn't exist. Does anyone think the biggest problem with Congress right now is drug use? This is just about you looking for a way to feel self-righteous.
I don’t think it’s valuable to have politicians punch a time card or ask for overtime hours. In this respect at least, they should be held to lower standards than cashiers at McDonald’s.
Elected representatives should represent their constituents. “The public’s policy preferences are incoherent” does not justify taking the losing side of a bunch of 80/20 issues.
The only thing that should be an absolute disqualification from running for political office should be Republican affiliation or sympathy. Who gives a shit what drugs they take if they’re a Democrat
Whether drug tests are good policy should depend partly on whether there is a drug problem with US politicians. I don't think there is an issue at the moment.
In the UK we do have some issues with MPs doing cocaine (or buying it for sex workers).
>A policy change that saved some lives while dramatically raising insurance prices might cost lives through a higher uninsurance rate.
This is the succinct framing I’ve been looking for, thanks Matt.
Man, I am really not looking forward to the coverage of Mangione’s trial over the next year. I expect to have to listen to friends I otherwise consider good and moral people sully themselves carrying water for a murderer :(
Unfortunately, the same people that think the CEO of a healthcare insurance company kills trillions of people a year also think that "the company charges lower premiums and increases coverage, but takes less profits" is a meaningful alternative
I was shocked by the number of ordinarily thoughtful and ethical people who reacted to the murder with "murder is bad, but our insurance system is killing people." In the vast majority of cases the types of insurance company behaviors that they thought were killing people were things that are illegal, usually as a result of Obamacare so these practices have been illegal for over 10 years.
Most favored single payer and were convinced that single payer was the only way to get rid of these already illegal practices. And they seemed rather shocked when I pointed out that one of the big problems is balance billing and providers have been fighting laws that require them to accept fees of some multiple of Medicare rates when they are out of network. I don't see how an insurance company paying 2x the Medicare rate instead of 5x Medicare that the provider wants is the bad guy.
The police seem to have done a rushed job and focused a lot on content creation rather than police work. I’d appreciate a very memorable demonstration of why work comes first and Mangione seems like the least dangerous person who would also provide that.
I share your concern with due process, but I would really, really like to see every politically motivated assassin sentenced to prison ASAP in the current climate. If Mangione genuinely was not the shooter responsible, I hope that comes to light so the real killer can be found. If he was responsible, I hope the police gathered enough evidence in accordance with the law to put him away for life. Any other outcome is a bad outcome.
According to the "defense attorney," the police did a rushed job. The defense attorney fighting a very long uphill battle.
To clarify, several of his defense attorney's motions to suppress evidence were basically attempts to remake case law in his favor. The more recent "revelations" are just the pointless details true crime amateur sleuths obsess over.
I wonder what percentage of the 78% who think voting in ways contrary to what the majority of people want is "corruption" actually know what the majority people want.
The question wording is a little weird, there's a whiff that this vote for one's social group or "elites" has a pay for play nexus.
But, there's a long line of political rhetoric against "special interests" politics and a long line of political rhetoric against "moneyed interests." And, Matt's own "stationary bandits" rhetoric is much the same. So, I think it's worth taking at least semi-seriously and file under more research needed.
In addition to this point, when you define corruption so loosely, you're always going to be disappointed in a nihilistic way since you've created a nebulous definition that will just shift to reflect your disappointment in life. "Corruption" isn't some obscure technical term thrust on the public. Everyone should be able to figure out what it is pretty easily.
I agree that the online pseudo-idealistic cynicism is unhelpful. But, assuming this is tapping into a more basic disdain for cozy deals or special interest favors it's worth thinking about. I feel like any anti corruption reform proposal that assumes everything was fine until Trump came along isn't going to move the needle.
Pseudo-idealistic cynicism is a great term for describing this type of outlook.
I'm not sure if any reform would necessarily have to deal with the pre-Trump world. But if you're defining corruption as "votes in a way I don't like" instead of "selfish quid pro quo deals," you've basically defined corruption so broadly that you can't really have rules in place to deal with it. You can enact reforms around Congressional stock trading, the types of jobs they can take a few years after leaving office, etc. But are you going to have rules governing how members of Congress have to vote? When you define corruption so vaguely, you have no way to measure if any reform has increased or decreased corruption.
I've had someone tell me with a straight face that a state that has a a trifecta is a "dictatorship" and was surprised when I informed him that Russia was one. I don't really know how you deal with such people.
> "Corruption" isn't some obscure technical term thrust on the public.
That’s exactly the problem. If it was a technical term, we should be able to figure it out easily. But when it’s just an intuitive term that everyone throws around in different ways in different contexts, it’s not at all easy.
But defining it well and "claiming it" more forthrightly would have many political and practical benefits right? Corruption should include:
- receiving or directing any consideration for pardons or sentence reductions;
- using non-public information obtained from governmental sources to trade or make investment decisions;
- directing agencies to pursue criminal investigations or legal proceedings based on personal or financial motivations;
- directing any public benefit toward family members or business associates...
...and on and on
There is a very long list behaviors by members of all three branches that should be outlawed, and the public understands that. The problem is that this list of strict but sensible and politically appealing prohibitions won't pass Congress until one party is willing to bite the bullet and promise to live under the constraints it creates, "Contract with America" style.
There is a balance, there is also a problem of people defining it so narrowly that is causes them to ignore corruption. The anglophone world has very little bribery but lots of retired politicians getting very generous speaking fees and non-executive directorships.
I think this loose theme of corruption has legs though. It might also pull in some of the anti-rich folks while being more accurate - like a lot of big corporations are actually f---ing you over, and that's "corruption" in some vibes way...
This line of thinking is hugely corrosive to society because it diverts attention away from real corruption by muddying the water and making fighting it harder.
This is a common tactic of corrupt authoritarian governments because it makes less politically active people assume corruption is everywhere and believe it's hopeless to try to do anything about it. It also creates a permission structure for more corruption since everyone is corrupt anyway.
It has a lot in common with claims that the US is has become a fascist nation because of Trump. This is a similarly corrosive attitude because if the claim were true, fighting it is a lot harder than if the US is just a nation lead by fascist wannabees that so far have had their fascist tendencies constrained by the institutions of government.
Superliking™️ this comment for articulating my thoughts better than I have been able to this morning.
The widespread default to thoughtless “reasoning” like this seems to be a throughline for a lot of stuff I’ve read in my various (too many) substacks this week. I’m a longtime SB subscriber and I think this is the most depressing mailbag, possibly the most depressing post, I’ve read here.
Not sure why you assume that actively pursuing the goal of ending corruption in politics (made vivid by Trump's actions) is "divert[ing] attention away from real corruption." It is focusing attention on real corruption.
To me the premise of the question is that the majority’s wants are known—their district just had a terrible weather event and they expect their rep to advocate for them.
Or if you replace “social group” with one of “the groups” Matt occasionally mentions and the examples seem numerous.
I think most people consider their representative’s mandate to be for the good of their district and to a lesser extent the good of the country and if the rep doesn’t know what is good, then the majority of their district should win over the rep’s social group. “Corrupt” might not be the precise word, but I think it is the word most people use to describe a politician behaving badly.
Newsome did a long friendly interview on Ezra Klein's podcast. I'm still against nominating him, but I have to admit the guy can talk - either authentically off the cuff, or at least close enough to fake it. That's a skill the nominee will need IMHO.
He is indeed a very good communicator. And, Bay Area pedigree and Pat Reilly hair aside, I personally think he mostly gives off "normie" vibes.
For all the reasons Matt states, it seems like it would be a bad idea to nominate him, though (at least if beating MAGA is high on your priorities list and so you therefore want to maximize your odds of victory).
That said, I can't find myself too terribly afraid of the prospect of Newsom as nominee (though I probably *should* be more concerned). I can't help but think if he actually had a limousine-liberal glass jaw, it would probably have shown up by now. Newsom really couldn't flip three or four states in a pro-Democratic cycle? I also think there's a decent chance we may finally get a not-so-close election: Trump is ruining the country.
But this is all just vibes based. Probably the election will be close again. And the cycle might well favor the GOP, who knows? So, the conventional wisdom remains: avoid nominating someone whose main qualification is beating other Dems. I myself am gunning for Besehar-Gallego.
That could be the case. I'd also be happy with any combination (pick two) of Shapiro, Gallego, Kelly, Buttigieg, Whitmer, Raimondo and one or two others.
I'd like to think if charisma is an issue for Beshear, we'll find out very early. Maybe even before Iowa.
He argued for extending the ACA subsidies, hit Trump on tariffs, and avoided taking the bait on a gun control question towards the end. I don't know how much he will excite news junky liberals but at least he seems to be a comfortable speaker.
My POV is that most normal people will NOT listen to 2 hours of him talking, and I think the first impression of a slick California Democrat is negative. People who give him a chance might be converted - but most people won't!
Versus someone like 2016 Sanders - I did not agree with his politics/policies, but I could see why the first impressions were good ("this cranky guy understands that I'm getting screwed over here! finally somebody gets it!")
I suspect he has a ton of things like the California Agricultural Land Equity Task Force, which will get dragged out and raked over until hell wouldn’t have it. Sec Rollins is already putting out press releases about it - has made the farm news, not general yet. As in
“[T]he United States Department of Agriculture (the Department) writes to express substantial constitutional concerns regarding the state of California’s proposed redistribution of agricultural land based on race, ethnicity, and national origin. The proposed policies would grievously harm farmers, ranchers, and agricultural producers,” the Secretary wrote in the letter.”
I personally think a reasonable reading of the Second Amendment allows bog standard, rich country gun safety regulations—no repeal is needed—just good faith judges.
But regardless of where one stands on that point, yeah, it's nuts for a politician with national ambitions to espouse such a policy goal. It's both utterly unrealistic *and* political malpractice of the highest order.
Republicans will have to nominate someone truly terrible before I will vote for Newsom. He signed Senate Bill 132 to allow males with penises to be housed in women's prison cells. There was an existing rule allowing males with bottom surgery to housed in women's prisons, but that wasn't good enough for the ACLU, they wanted men with intact penises to be able to access female prisoners. Not surprisingly there have been many many cases of women being beaten and raped in prison since 2020. Newsom is very beholden to the groups.
The problem for me is that I suspect Newsom is bad on the merits. He’s never really supported any good policies as far as I can tell, and he’s often campaigned on actively bad ones. He might or might not be electable, but he’s not someone I trust.
I feel like we’re going to have to get back to good policies waaaay down the line. In 2029 we might need to be, like, rebuilding the entire department of education and figuring out who needs to go to jail for out of control crypto corruption.
Biden’s big promise, which he kept, was “hey guys that was a crazy four years so let’s get back to just governing, huh?” And it just doesn’t stick. We might instead need someone who can take really big, maybe really partisan swings. I would love it if they also had correct opinions about permitting reform but I don’t know if I can get my hopes that high.
I honestly haven't studied his gubernatorial administration in any detail. California seems to be doing about as well as anyone these days in pushing against NIMBYism—that's one mark in his favor in my book.
It’s not for a lack of trying but I just can’t get myself to dislike Newsom or be that worried about him winning the nomination. And that’s in contrast to “getting” the nomination - as someone else pointed out, no one is out here saying it’s Newsom’s “turn” like it was for Harris, and sort of Biden, and Clinton. There’ll be a real field, and if he wins through it then he’ll probably have done something right.
But on the interview it’s really striking to me the extent to which he’s willing to take (rhetorical) accountability. In plain non-squirming language he’ll out-and-out say “I was communicating the wrong way about the economy” or “we were wrong about the approach to the border”, both issues being good ones to reverse on but also both framings of “I” and “we” seem really important to be able to deploy. And also, I would think Matt would appreciate this exact approach more. He’s always saying the way forward isn’t normie vibes, it’s being able to publicly, convincingly moderate on specific unpopular issue positions. Is anyone doing that as well as Newsom?
The positive case for him over the Dems last three nominees is that he isn't heir nominee and if he gets the nomination he will have to build his own coalition. He seems like a decent communicator and a more willing to basically do what it takes to win.
That said, West Coast Dems really are a different breed and there's a lot in his record that will be vulnerable to attack. And while he seems like he has some political skill it's all trained in that particular political environment. All Matt's list is more interesting to me than Gavin.
Californian here. The positive case is that Gavin Newsom is incredibly like Bill Clinton, except for the one big disadvantage of not being the governor or a red state. But he is utterly without scruples and endlessly adaptable, so he will assemble any coalition and do/say anything it takes to win.
And he looks much more presidential than most candidates. If I was casting someone to play a Senator or President in a movie or TV show, I would pick Newsom. That is probably worth 5 points in America. That hair!
He sounds confident too. I still remember when he and Trump had daily briefings on Covid. Night and day difference.
That’s fine. The important thing is that we have a Democrat that can win. The second most important thing is that we have a Democrat who once they’ve won will do the worst things that Trump imagines doing in his fever dreams to Democrats, but to MAGA, so we don’t have to deal with this crap again. The next Democrat needs to seize enough power to completely, permanently destroy MAGA. I don’t really care what else they do while in office.
The fact that Newsom actually brings some testosterone to the fight is a huge plus. I don’t think he’s that scrupulous, and that’s also a plus - he might actually do the necessary second thing. But the California factor will probably prevent him from winning, and that’s a necessary precondition for anything else.
Another life long Californian here (until 3 months ago). He is Clinton like, but without Clinton’s smarts.
I always say CA did well Despite dysfunctional Dem politicians, not because of it. While I do believe GN will do less damage than Trump, can we have someone better?
One time I was in a restaurant in my very purple town and I overheard the next table talking loudly about how they were huge fans of Newsom (a thing I have never heard from my reliably liberal friends), which was a bit shocking to me given what Slow Boring had always said about his lack of appeal to swing voters. It made me wonder if I can really rely on Slow Boring to know what residents of purple places are like. Of course this story is statistically useless but I do think we should remember that mocking internet leftists for not understanding swing voters doesn't give you yourself a royal road to understanding them either.
Maybe, but it's worth noting that even in a purple town 40% of people are pretty reliable Democrats, so the odds are high the people you heard are not swing voters.
The swing voters in my family from Nevada really like Newsom too. I'm sort of surprised that SB is so bearish on him - prior to this week, my impression was that far lefties hated Newsom for backing away from medical care for undocumented people and trans women in sports but that relatively disengaged voters like him because he's slick and snarky and comes across as a moderate.
I think your impression is correct. Slow Boring doesn't have any disengaged voters, though.
I think Newsom is being underrated in the same ways Biden was in 2020. He's likely to be the frontrunner, although I don't think any individual person is over 50% odds.
Oh, of course, I have no idea who those people were. What surprised me was that based on the way people on the internet talk, genuine enthusiasm about Newsom was not something I expected to hear from _anyone_, swing or otherwise.
I just finished commenting on how after his recent interview with Ezra Klein, I walked away thinking I could really see the swing voters in my life going for him. He's got that funny, bulldog personality that so many fell in love with Trump for, but he channels it much more productively.
He did good but I think he would have such a stronger story if he had another term of “fixing California” and wresting governance from the hands of crazy leftists. That would be an awesome story to run for president on, “I saved California from the libs!”
The problem is that California has been so poorly governed that the attack surface is massive. Republicans could credibly run adds about California having arguably the highest poverty rate in the US and most expensive housing and it will be true
Fascinating. I thought that was a sort of throw away comment while the two of them were just bantering.
I guess with well-rehearsed politicians, little of what they say is ever off-hand or throw away. Everything is probably focus group tested. Not sure what this says about the value of focus groups.
Given that 960 was a pretty atrocious score even when Newsom would have taken the SAT, I'm guessing that he's been advised to bring it up a lot now to defang it as an attack line later.
I was going to say… not to be a crank, but SAT scores correlate moderately positively with IQ, and I’d be genuinely worried if Newsom were sober taking that test.
He also did a good one with Tim Miller on the Bulwark yesterday and while I don't really know enough about Newsom to disagree w/Matt's assessment, I didn't hear anything in this interview that seemed like a huge red flag. There's an especially interesting part of the convo about Charlie Kirk and Turning Point USA:
Anecdotal, but when I talk to normies, the French laundry hypocrisy is what they always bring up. Would be hard to shake that. Hell, even I find that hard to get over.
It really is unfortunate that the ACA has become a kind of orphan. I'm one of the people who thinks it didn't go far enough but M4A isn't the only way to achieve a good system, to say nothing of those who hate it for no reason other than its association with that devil Barack Hussein Obama. The problem isn't necessarily the payer (i.e. public or 'private') it's the patchwork nature of the system. There's enough there in the bones of the ACA to consolidate the insurance market into a more effective universal coverage system that people can navigate in a reasonable way, plus reforms to push for more retail-ization of healthcare. Yea it'd all end up looking like a big box store rather than a social democratic paradise (or... I dunno a place where people are denied care for fun and profit or whatever the GOP vision is) but that's just how more or less effective things end up being in America.
OMG is this true. I have a high deductible ACA plan and I needed an MRI that wasn't an emergency. I tried figure out how to get the lowest cost MRI from respected in-network providers, based on insurance negotiated rates.
The process was frustrating and took around 3-4 hours. I needed to practically become a medical billing expert and learned all about medical coding. The highest price was over $3k and the lowest price was $400. I was convinced the $400 price was a mistake, but went for it anyway and it did work out.
I have no idea why prices are so varied for a standard in-network procedure that's somewhat common.
I think there would be lots of value in local journalists calling up local companies asking for MRI quotes and then putting the names of the ones who refuse to answer easily on the front page.
Someone could start a website and crowd-source it. A Substack for medical price lists. MRI_prices dot substack dot com, sinuplasty_prices dot substack dot com, etc. Substack is maybe not the ideal format for searching, but once it's posted online you can google it and include "substack" in the query.
Social media would be better --eg reddit. People could post prices and geographic location on reddit, mods could compile a list of verified users, and they could manually or automatically compile prices by year and MSA (or by state for non-MSA counties) to make a sort of volunteer-run census of medical prices. Reddit is good at getting volunteer labor, the problem is spam, hence the list of approved users.
I remember reading an article a couple of years ago (NYT, I think) in which a doctor who worked in the hospital couldn't get a straight answer on what the cost of his MRI would be.
Price transparency is huge. Also removing the dependency on employment. Get those 2 things resolved and it would act like a much more efficient market.
The ACA did remove the dependency on employment, at least in the sense that if your employer doesn’t offer coverage you can get it on the exchange. I was able to go straight from law school into solo practice because of the ACA
I'm not a tax expert, but I think self-employed people generally get to deduct their ACA premiums as long as they have enough net business income. The catch is unless you set up some sort of corporate tax entity (like an S-Corp), you still have to pay the full self-employment tax (2x FICA) on that income even though you get to deduct it and avoid normal income taxes.
I believe normal large company employees don't have to pay income tax or FICA on health insurance benefits, the premiums are all paid by their employer fully pre-tax.
Dependency on employment is trickier, since most (est 63%) employer insurance is self insured, with the insurance company acting as a claims administrator / stop loss provider rather than acting as the insurer.
Yeah, this is interesting, though it’s definitely the weeds. I have state employee health insurance that’s administered by a Blue Cross group. I just looked it up and saw that the state is self-insured. I should yell at my state Congresscritter to pay my damn ozempic
Tell me about it. My doctor wanted me to get a bunch of tests done. Not only couldn't I find out how much my insurance would cover, I couldn't even find out what the out of pocket costs would be if I paid myself because of complicated pricing models. I am lucky that I have disposable income, so I could pay the resulting $580 bill, but the tests didn't reveal anything new about my health situation. If I was a person living closer to the margin, I would have been really mad at myself for making the decision to get the tests. I am still annoyed at myself for not asking more questions.
I think we need to mandate all prices be posted online, and also ban price discrimination by providers. IE the provider shouldn't be able to charge different prices to different payers for the same service.
For competition to work we MUST have price transparency.
Congress ordering healthcare providers to make their prices readily available would go a long way to fixing the exorbitant and unpredictable prices and confusing billing that plague US healthcare consumers.
Mental decline tests strike me as quite dangerous when considering who gets to design the test, and how it could be used for ratfucking purposes. Drug tests seem like a solution in search of a problem. Agreed with Matt on tracking time being terrible. Town hall meetings would have to be calibrated very carefully to prevent grandstanders coming to just yell at politicians they don't like.
I hate to fall into the "no, it's the voters that are wrong" pit, but...
Not sure I agree understand your first objection. Cognitive assessment tests already exist and are used by doctors in a completely non-partisan manner, just take an existing test and require all elected officials above [insert age] to take it every 6 months or whatever. Where is the “ratfucking” potential? It’s not like “white people get to read a simple sentence, but black people must read and interpret a complex paragraph in order to vote.”
/scientist hat on
Make it a written test, and have it scored by two doctors (working separately) who don’t know who the test taker is. Like, give each doctor a stack of five cognitive tests, where one of these is from POTUS, one from an 80-year-old Senator, two from 80-year-old private citizens, and one from a 25-year-old congressional staffer just for fun.
The issue is that all of your guardrails require very honest people doing very honest work. Except that this test presents a very juicy opportunity for anyone that can game it in thier favor. Not just money but control over the most powerful government in the world.
There’s zero chance that the political class would let two doctors determine who wields power. Either they’d nerf it or use it for ratfuckery. No other possibilities.
It's certainly possible to create a neutral test as you describe--I worry that politicians are going to politician and try to rig such a test in their favor.
When I was a professor at Texas A&M, there were constant murmurs that legislators were going to start requiring us to track the number of hours we were in our office on campus. The university administration told us that the legislators were constantly suspicious that none of us were taking medical leave in order to go to doctors appointments. I guess that’s a thing that office workers with strict 9-5 schedules have to do?
Even those without strict schedules in many cases. My job requires this, and I'm not paid hourly. If it's 30 minutes at the end of the day they're lax about it but if I'm going to miss 3 hours to go to/from the dentist then I need to use sick leave.
Neither my husband nor I have had to use " medical leave" to go to an appointment. We just agree to make up the time elsewhere, work through lunch one day, etc.
When I was a time card employee briefly yeah sure, but not normally
Um, I have never heard the term "ratfucking" before, but I'm about to tell all my musician friends about it because we need something that vulgar to describe some of the behaviors in the industry. Currently, we call that "shenanigans", and I want to throw something every time I hear someone say that.
It's really great vulgar slang for using dirty tricks to defeat one's political enemies. I'm sure that there's plenty of ratfucking that similarly compares in the private sector.
Update: I posted a PSA about the availability of the term "ratfucking" on Facebook and the nice older ladies from the park that had me over for Thanksgiving were so offended that they didn't even accept my apology after I brought them a cinnamon bun!! ☹️☹️☹️
I think I need to make a filter so not everyone can see posts where I swear.
I feel so shamed!! Like, c'mon, we're all ladies here! It's not like I'm some 10 ft tall jacked leather man in a bar that's swearing and making people nervous that I'm going to accidentally elbow them in the face!
It's part of why I'd much rather go with a maximum age of 70 for running for office. We have minimum ages, so I think we should have maximums as well. It's very easy to verify age compared to mental acuity.
That Searchlight finding is a depressing warning siren:
"[O]ver three-quarters of voters (78 percent) consider a politician corrupt when they vote the way that elites in their social group want, instead of what most people want."
That number is crazy!
Taken as a 𝗱𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝘃𝗲 claim, it shows how Americans continue to live in harmful ideological bubbles. When "everyone you know" agrees with a policy, the only possible reason someone might vote otherwise is that they're on the take.
The 𝗻𝗼𝗿𝗺𝗮𝘁𝗶𝘃𝗲 claim it implies is equally bad! People have accept that public officials will have to enact unpopular policies from time to time. To act or believe otherwise is childish and petulant
I interpret that to mean that, given Bob and local elite Alice, when politician Carol votes in ways Bob disagrees with, Bob infers that Carol is promoting Alice's interests over Bob's, either in an explicitly corrupt way or a more nebulous sense (i.e., just another instance of "the rich get richer").
I saw that attitude first-hand a month ago during the elections, when it was all over Facebook and Nextdoor. A contingent of unhappy voters were furious with our deeply progressive mayor and city council for spending reserves on capital projects rather than increasing the school budget. They conjured wild conspiracies to explain the politicians' unwillingness to implement the insurgents' preferred policies (and almost succeeded), and when they didn't suggest run-of-the-mill corruption, they implied it in more general terms like "this town is run for the rich."
Related: paying close attention to local politics taught me that you 𝘢𝘳𝘦 going to make enemies, so successful politicians absolutely have to make friends too. Preserving the status quo, no matter how good it is, isn't good enough.
There are 2 definitions of corruption: corruption of the soul (that is, being part of MAGA) that’s getting confused with textbook corruption like embezzlement or graft.
The public broadly isn't Burkean - because we operate in a representative democracy with comparatively few intervention points and little leverage once they're in office, it's not crazy for the public to want elected officials to faithfully represent their collective views as much as possible. Progressives want power and a quiescent electorate who'll let them transform society in a favored direction, something national voters have rejected.
I really don't get the Newsom love from some people, and they get pretty irked when I say he's a worse version of Kamala Harris. Some hardcore Democrats really struggle with the idea that delivering sick burns to the opposition (see Jasmine Crockett, too) isn't what makes politicians electable in difficult races. Those people are nice to have around, but they should be running for most offices.
I think giving 2028 takes before the midterms is fundamentally a foolhardy endeavor. Nonetheless, he is clearly a better communicator and more willing to change his tack when things don't work out than Harris, who seemed like a deer in the headlights anytime she got tripped up on something.
I won't compare him to possible 2028 contenders. It's too early, but he seems better than Harris. The sliminess allegations just don't hit that hard at this point in time.
Even the slightly more erudite version of this demonstrates a failure to put themselves into the mind of an opposition voter. I often see something along the lines of "Buttigieg would be a great candidate, look how he goes on Fox and adeptly ridicules the arguments the hosts offer him." And, like, OK, when a Ted Cruz or some other conservative with fairly high verbal acuitity talks circles around a liberal, do you find yourself more kindly disposed to them?
Are there people on the American left who would even admit that it's possible for there to be such a thing as a "conservative with fairly high verbal acuity [who] talks circles around a liberal"? (I'm 100% serious in asking.)
Are there examples of this happening that isn't just dunking on college kids?
Buttigieg is specifically good because he goes toe to toe with the conservative pundits.
I would wager there are some good conservatives that can hold themselves well. Tim Miller would have been a good choice, but a lot of them are getting rebranded liberal without being a democrat. Nothing wrong with that, but it makes the search for conservatives examples difficult.
I have no clue if there are any examples of that which aren't just dunking on college kids because it's not a thing I go looking for. (I'm not familiar with Tim Miller, sorry.)
Whatever anyone thinks of newsome he is not Kamala Harris. He’s very very good on his feet and as governor has made some shrewd and difficult policy decisions with tradeoffs. Frankly, he also has much much more experience in governance than her.
I don't disagree with anything you said, but I'm curious who these haters are. If they're leftists, or even center-lefties, then that's a good thing.
Frankly I have very Trumpy family that think badly of California but like Newsom as a slick talking guy with a veneer of "success" to him. He could win their vote. Harris could not.
I think Newsom is a pretty good foil for Trump. But around 2027 I’m starting to think Trump will be a paper tiger given his obvious decline. We’ll have to see who the anointed successor is.
Mississippi Miracle aside, and without claiming that CA is well-run (I think there’s good and bad), doesn’t that sound like every American state’s educational statistics? As a country we don’t do great when it comes to educational achievement. You could quote me that same statistic about any state and I’d be like “that’s plausible.”
It sounds like louisiana and tennessee are doing even better. And the results lasting longer because they're focusing on a content rich curriculum.
I believe florida is near the top as well.
Some states really do seem to be determined to fix what's broken in our education system.Other states seem to be too beholden to special interests.Including large publishers and of course, teacher unions
The national average for Grade 4 NAEP math is 237. CA average is 233, while Miracle Mississippi is 239. Do we have something to learn from MS? Absolutely! But a 6 point differential is hardly "crushing."
I think we should be a lot more focused on Massachusetts (246) and New Mexico (224)
Maybe. The question is whether Gavin Newsome is the cause of that and whether he can fix the alleged poorly run issues. It seems to me that California has poor local governance and messy statehouse. On the latter, he may have some influence, but to what degree is not clear. And he has pushed back against he legislature and sought to override local governance issues (like housing). So I think the question is whether Gav is responsible for fixing these issues, and I am not quite so sure the Governor can.
I agree that the shit posting is not, necessarily, a plus. But the main criticism I ever hear is "Democrat" or "California." Some will get spicy and go with "California Democrat."
Is his track record really that abysmal? Why is California not already a difficult position to hold? That is, by the logic most are pushing forward, California must be an easy place to both win an election and do a job well enough to survive reelection...
Newsom is a successful Democrat in a very blue state. I don't hate him as a politician, I think he's done a useful turn recently to the center. I think the "hate" (of which I am a participant) is regarding his prospects in a national election against Republicans, neither of which he's done before. I would put his chances much worse than the current Polymarket rate.
Also I don't think people (either justifiably or not) would consider California to be a "well-run" state. The taxes are high, people are leaving (since the 90s, not really Newsom's fault, but they are) so it's hard to point to CA as a success story for the Democrats. As Klein pointed out, we've sunk billions into a rail project that might get you from Merced to Fresno.
I'm largely comfortable saying he has weaknesses. I'm similarly ok thinking there are probably safer choices. What blows my mind is nobody ever really gives specific reasons. They barely give vague reasons that don't boil down to, "the nation distrusts California."
Is there a longer form take that shows why California isn't at least a decently run state? I agree with some of the wild education nonsense being nonsense there. Is this Newsom's doing? Is it not somewhat correcting, now?
I think CA residents, myself included, are roughly satisfied with Newsom's administration. That doesn't mean people who don't follow CA politics (which includes most Californians) won't ascribe many facts about California to Newsom himself:
- High taxes
- Companies (like Tesla) leaving the state
- Very high housing prices, and cost of living in general
- Free healthcare for illegal immigrants
All of these are undisputed, and all of these would be very effective weapons against a Newsom presidential campaign. Harris had none of these anchors. Also I'm sure with little work one could find the type of far-left statements that hurt Harris in Newsom's past as well.
"I think CA residents, myself included, are roughly satisfied with Newsom's administration."
Newsom's approval rating has gone up recently but he wasn't a very popular governor not so long ago compared to other popular Democratic governors in swing or red states.
I think the spends billions in taxpayer money on “free healthcare for illegal immigrants” is pretty much enough to sink any candidate outside of California. Imagine that ad campaign repeated every twenty minutes for four months.
Right, this still largely comes down to "CA bad," though?
And to be clear, I agree these would be effective weapons. My pushback is that I don't understand why we let a lot of them stand as acceptable with absolutely no pushback. This should get the same pushback that people accusing MS of being a bunch of ignorant hicks should get.
To a point I agree, but why not field a candidate without these liabilities? If Newsom already won the nomination, then sure, you don't just let all those critiques stand unchallenged.
But In the era of 15-second takes, I'm not sure a "but actually Newsom isn't responsible for all those bad things in California because xyz" message is really going to land.
As a California Democrat I just dislike Newsom on the merits. He hasn’t really been on the side of any good policies for the state, even if he has occasionally gotten out of the way of some things. Compare him to Jerry Brown or Barbara Boxer, or even the slimy Antonio Villarraigosa!
I live in Washington State and every day I am thankful that Washington State isn't as badly run as California. Some of this has to do with the fact that California is so much bigger, but a lot of it is that politicians run it badly.
I balk a bit at us having fewer corruption scandals. Open to the idea that the police chief nonsense just stuck with me, though. Searching online, it seems that both states are middling in this grade. Curious if you know of any data to dive on that one.
Similar for housing, I would not have thought of the Seattle area as having affordable housing right now? Happy to hear if I am wrong, there. And if not talking about the Seattle area, I naively assumed there were cheaper parts of CA, too? I will also point out that CA built literally double the number of homes in 2024 than WA did.
I think the per-capita rates for home building are more important than the absolute numbers. We may have built twice as many homes as WA last year, but we have more than 4x the population, so the rate is functionally half as many, I think.
To really understand why I consider California badly governed, I'd take 3 anecdotes:
1. I went to public high school. When I took my first chemistry class in college, I realized why my mom always said that my science labs were lacking. The first lab had a bunch of metal salt reagents, and many of my peers said that they'd done the lab in high school. Meanwhile, my Chem teacher had pretty much only had us do labs that could be done with grocery store chemicals because there was no school budget for materials. The moral of this story is that because the state has never repealed Prop 13, poor districts have bad schools while rich districts who can raise parcel taxes on themselves are good.
2. The boomers I know who grew up in California were easily able to work and buy houses here. All the millennials I grew up with who still live in the Bay Area basically had to get their houses from older family members. Everyone whose family didn't have a house which they could get a family discount on has moved out of state for lower housing costs.
3. PG&E has been too lightly regulated. Their failure of maintenance has caused so many fires over the years.
What makes it a shithole state? Even better if you can be specifically in terms of governance? But I'd be fine with just what makes it a shithole state?
It's a very high tax state that can't get anything done. Public education is poor. Major cities have glaring problems from homelessness to public safety. Couldn't build HSR in close to 20 years. Public transport and infrastructure are poor. Home prices are ridiculously high for the average person and home contruction lags other well governed states. Even permitting for green energy is such a shitshow that it lags Texas in solar. I can't name a single thing that's handled by the state or local governments that's better than states with low taxes.
Is it actually a high tax state? My understanding is the top end rates are high. Normal tax burden is on par with every other state. Similarly, hard to complain about them not getting things done when they are the most active economy in the nation.
But your examples are exactly what I am wanting to stop taking as a given. They do not meaningfully lag TX in solar. They were just so far ahead of everyone else that their growth has slowed. (Well, that and quibbling over large projects versus many installations. CA has more total capacity still, but TX has more "utility scale" generation.)
Similarly, the transport and infrastructure are poor compared to what we can dream of. They are almost certainly still better than any comparison you can make in the states. Specifically for the amount of work that is getting done.
"Similarly, hard to complain about them not getting things done when they are the most active economy in the nation."
Private sector is not the same as public sector. Tech and the film industry benefits from access to a global market and talent. Actual growth in tech employment in CA is flat to negative the past 3 years. None of these have anything to do with the state government of CA BTW.
"Is it actually a high tax state?"
Yes, it is. You become a high tax state when you have every kind of tax that's possible and those rates are high. People nit pick about property taxes but when you have ridiculously high property taxes, your property tax burden is automatically high.
"CA has more total capacity still, but TX has more "utility scale" generation.)"
Me having solar on my roof is not an achievement of the CA state government.
"Similarly, the transport and infrastructure are poor compared to what we can dream of. They are almost certainly still better than any comparison you can make in the states. Specifically for the amount of work that is getting done."
I have no idea what you're talking about. FL has HSR, CA doesn't.
Neither BART, nor the LA metro are better than NY Subway or Boston. East coast in general is better at it.
Right or wrong, CA is perceived as being poorly governed by both the right (DEI, taxes, cost of living) and the left (inability to build, homelessness, also cost of living), so I think that's the biggest hurdle his campaign would need to clear.
My point is that this seems, at face value, wrong. I am not arguing that these aren't the points people will bring up. I'm arguing I wish people would just stop accepting them as given.
Note that I'm comfortable saying this should not be fought along side the presidential race. There probably are safer choices. I can still have a moot debate about the problems with this view.
To be even more direct, I'm worried that the focus on "electability" is going to land us in the same seat Republicans have found themselves in. People that can win elections but have no concept of how to actually govern. It is frustrating.
As a California Democrat who's voted for Newsom plenty of times, I've never liked the guy. He's always seemed like he's only in the current job as a stepping stone to the next job and like he doesn't have any real core values.
I also just don't think we should be putting California Democrats in national leadership positions in general. We're just way too far away from the median American voter in the way we talk and think.
It's hard to describe this quality exactly, but I think his response to dealing with our high-speed rail boondoggle is informative. He's the one who downscaled phase 1 down to be Merced to Bakersfield from the original ambition of SF to LA. He was correct in thinking that the current project has cost too much and taken too long. However, to me, opening a line between Merced and Bakersfield is basically trying to get anything done whether it makes sense or not. Someone with real vision would look at the same set of facts as Newsom, figure out what would need to be done to rescue the LA to SF vision, and get to work trying to do it. No one wants or asked for a line between Merced and Bakersfield, and it's lame to leave it there.
Additionally, housing scarcity and homelessness has been a problem in every position Newsom has held in his career, but he only got on the YIMBY team after Abundance came out. He never bothered to do anything about it before because he didn't want to be unpopular with NIMBYs.
I guess my overall problem with Newsom is very similar to my problems with Biden: if a president doesn't have his own clear objectives for the job, then how will they prioritize? I want to know what they want to do with the job, and Newsom is a cipher on that front.
To defend Sam's wife's intuition (a good spot for me to pick, I guess), strictly providing poor people with more money isn't always the right play. We also want a broadly inclusive society rather than one that's completely stratified by ability to pay.
To pick a different example, the lifetime earnings advantage of going to a fancy private university is plausibly less than what the university pays in financial aid for poor kids. So in some sense "everyone would be better off" if Harvard gave the kids the money, the kids went to Wisconsin or Georgia or Arizona, and Harvard was 100% rich kids. But obviously that would be terrible for our society and no one would do that. The argument that having the Vatican Museum or Taylor Swift shows or NBA games be 100% for this would be bad is similar if less extreme.
A couple of other points. 1) Some people, including myself, enjoy things at least partially based on a feeling the price paid was equal to or less than the value received. That is, doubling the price of visiting the Vatican might decrease net enjoyment, even if the experience delivered was objectively superior. 2) Higher prices do not necessarily convey to the consumer that the good or service being pursued is in high demand in the way that crowds and waiting in line does. The Vatican may place some value on impressing that sensation on visitors.
Harvard manages this by having a limited number of slots that get given to legacies and donors and the rest are more open. I think concerts could do this by having a number of tickets given out by lotteries to superfans and a limited number sold at auction to the highest bidder. There are many ways to structure this to get the best of both.
"if Harvard gave the kids the money, the kids went to Wisconsin or Georgia or Arizona, and Harvard was 100% rich kids. But obviously that would be terrible for our society"
Because it's important that the important institutions of our society, of which Harvard very much is one, are open to people from every walk of life. Additionally, elite institutions replicate themselves -- it is more challenging to join the elite without access to elite institutions. And a hereditary aristocracy would be bad for America. (I can argue for that claim too if necessary.)
If they really cared about that, they would rely more heavily on standardized tests or have their own entrance exams instead of trying to screw Asians over by giving them poor scores on a “personality” test and expecting them to score 200-300 more on SATs than other minorities.
If they really cared about what? Their behavior is very consistent with their goals of having Harvard remain very important and maximizing the share of very important people who went to Harvard.
Cared about allowing people from all walks of life instead of cooking their diversity stats by admitting black kids from well off families from Africa or the Caribbean to make up their racial quotas over more meritorious students from poor families.
You should perhaps consider that (a) my goals and Harvard's goals are not the same and (b) admitting rich people from Africa who will go on to become important fits precisely with their goals!
Actually I think in your scenario Harvard just becomes much less important of an elite institution, which would be good (same for the rest of the Ivies).
Of course that's already starting to happen anyway
Why is it obviously terrible for society that Harvard has a smaller endowment relative to the counterfactual where they charge tuition for students whose families make less than $200k annually?
I must've misunderstood what you were suggesting. Harvard currently gives poor and lower middle-income students money to attend; if they jacked up prices and gave kids money to attend cheaper alternatives, their endowment would be larger (they're charging more than other schools cost so still making more money, and state schools are already pretty cheap). But before all of that, the obvious thing they would do first if they thought more money would help would just be to charge money from students who are already attending!
What I'm saying is that if Harvard gave low income kids 400k each to not attend, and they went to a state school, the literature on the marginal value of getting into a fancy school suggests that the poor kids would be richer overall.
But even if that's true the overall consequences of making important institutions in our society accessible only to the rich would be very negative.
I have never posted, but the Brian Thompson question and answer really missed the mark. The answer to Brian Thompson being responsible for some deaths is 100% yes. Just like Trump is responsible for some deaths. And Obama. Anyone who has to make allocation decisions around scarce resources is ultimately making it more or less likely that somone will live or die. This is not really why people cheered his murder. The reason people cheered his murder is that the public does not agree that the reason for making the allocation decision is valid. Everyone understands that the local government only has so much money and can only extend so much support for poor family heating susidies in winter. And we recognize without admitting it that the cutoff line means increased risk of death. But collecrively we accept that as just. We do not accept that it is ok to risk a person's life to increase corporate revenue or profits. That is conaidered unjust. Every time UHC took a person off some working treatment for Crone's disease to make them ramp back through cheaper treatements, they risked a life. Every time they delayed a cancer trial to cycle through failed treatments for the sake of revenue, they risked a life. And the resentment of forcing people to take that risk, and the resentment of their friends and families, and the fear that resentment inspired in others, is what people are expressing when they cheer his murder. People correctly understand that Brian Thompson made millions risking the lives of other people for money. They hate that idea, and they hated him for it. The stats, the economics, the pearl-clutching over violence all-it all misses the point. Brian Thompson made people feel scared for their safety, and what they really want is for leaders to protect them, not lecture them on whether the chain of causality really supports a reasonable definition of killing in a system with lots of variables and intervening causes. The inability to understand this is why Democrats have lost mass support among working people, and is also a big reeason Trump won a second term.
How is that different from what farmers do? Every time they try and charge more than what would keep they at bare subsistence they are cussing someone to go hungry.
I mean, not so much farmers because they were far away, but shop owners who were thought to raise the price of bread too high were frequently targeted during peasant riots. The difference is thankfully, thanks to advances in agriculture and heavy subsidization of the buying of food for poor people by the state, while there is hunger in America, basically nobody, outside of incredibly unfortunate cases of either homelessness or weird one-off cases, dies of starvation in the US.
Meanwhile, basically everybody is one or two people away from knowing somebody who was treated terribly by a health insurer.
Correct. And if farmers were getting millions in bonuses for driving the price of flour to $50 for a five pound bag and making people fear starvation or penury, then everyone would hate farmers and demand price controls. And it would be absurd to argue that it isn't a big deal because most people don't make their own bread at home, and carbs are unhealthy, and reducing grain production is good for the environment, etc. In the real world farmers, at best, make a reasonable profit and flour is readily available and affordable and we all accept the marginal tradeoffs.
Regarding crowds at the Vatican Museum, when I was there (admittedly a long time ago), focal tourist sites (think Sistine Chapel) were insanely crowded, but most of the museum was nearly deserted, though filled with fascinating and remarkable items of beauty and historical significance.
My recollection is that it had very small doorways between the galleries, which became choke points, especially for the crowds of tour groups.
Vatican Museum might be the only place I’ve been where the crowds were intense enough that I flat-out didn’t enjoy the experience pretty much entirely because of them. I was there in March, for what that’s worth.
I think Democrats should pay attention to groups like The Bulwark in deciding whom to nominate. #NeverTrump conservatives are a peculiarly valuable asset to the Democratic coalition because they have insight/instincts for what the public doesn't like about left-liberals and will naturally eschew it.
Anti-Trump Republicans completely lost control of their own party after the Bush and Obama years. They failed to stop Trump and seem to have drifted towards Democrats on the basis of high-minded democracy issues, which mostly seem to motivate people who are already entrenched on one side or the other.
These folks are valuable, but they don't seem to have any particular finger on the pulse of actual swing voters from the last three elections, at least any more than other parts of the Democratic coalition.
I'm increasingly warming up to the idea of a Bulwarked Democratic Party with maybe a dash of The Dispatch mixed in. Of course, warming up to what is likely a fantasy isn't particularly useful.
I posted this in another thread here, but Tim Miller did what I thought was an interesting interview w/Newsom yesterday, especially the part about Charlie Kirk about 40 minutes in.
underrated comment here. If liberal/modern societies can't figure out how to have a stable population they will be replaced by illiberal ones that can.
I was thinking more of sub groups within a population, not whole societies. Think Ultra Orthodox in Israel and US religious communities less exposed to the factors that contribute to population level birth rate declines.
Cortez and Pizarro conquered empires of millions with a couple hundred guys. The British ruled hundreds of millions in India with maybe hundreds of thousands. Israel dominates the entire Middle East today despite having 1% of the population of that region. Numbers just aren’t very important with technology.
Well, something like that... we've been down to around 60,000 individuals at some point right? We could potentially dip lower than the threshold at which those more religious subgroups (as we understand "religious") can't quite manage a stable population either, especially if they can't keep up with the agricultural production to sustain them.
A new equilibrium would be reached at some point; there's no reason to think that populations would keep ratcheting upwards.
Man, that last question represents a scary outlook on life. Not a long journey from that (wholly incorrect) line of thinking to one that justifies or commits violence. I worry that Matt's response is about 6 grade levels of thinking higher than the questioner can understand.
I find that line of thinking in the question to be really disturbing. And I really dislike the politicians who think those who echo it are voicing fair concerns about the medical system.
It just seems like an abstract question to me. Like how we attribute USAID deaths to Elon Musk. I hold him fully responsible for that, but that doesn’t mean I condone his murder.
It’s sort of like EA people arguing over how much suffering is caused by the shrimping industry, or how many future people we’re effectively killing with climate change. That doesn’t translate to firebombing a seafood restaurant.
Agree. Matt’s commentary is fine but I wish he had clearly stated “as far as we know the number of deaths that can be reasonably attributed to Brian Thompson is zero.”
The price of living in a society is that even if you can drawn a jagged or even straight line between him and someone's death (probably possible with any powerful person), you don't support his murder. If his behavior is unacceptable, you change laws; if he breaks the law you punish him with the justice system. We don't get to be a country of individual judge, jury and executioner - nor should we cheer it on even if it seems right by some kind of wild accounting - because living in that country would be hell.
We do get to make moral judgments about people’s actions though. And if we’re making moral judgments about the actions of a healthcare CEO they should be based on a realistic assessment of the impact of the choices he made, not a blanket condemnation of his line of work.
Certainly. No doing or cheering on murders, though!
I mean if we straight-up banned health insurance without instituting some form of universal care and just demanded everybody pay for everything out of pocket, almost certainly more people would die? So if we're going by this logic (which I don't buy), given the current state of law, he's saving lives.
I think the choice of counterfactual is important if you’re trying to attribute lives saved/lost because of a given insurance company CEO. are we saying the alternative is no insurance companies and a free market? No ins companies and NHS-style single payer? Brian Thompson being replaced with a CEO of a different ins company, or is he being replaced with some random guy off the street? All
Of those counterfactuals will yield different accounts of lives saved or lost. Without defining that it’s meaningless to ask the question of what Thompson is responsible for.
The best counterfactual is what should happen to the government bureaucrat that denies treatment under Universal Healthcare? Do you get to shoot them too? Because every government run healthcare system makes the exact same decisions that private health insurance companies make.
“Do you get to shoot them too?”
No, just the CEO.
Here I'm defining the alternative as "status quo with no health insurance companies."
If there was a case made that Thompson was a uniquely stingy CEO, then replace him with another, but nobody's made that case. It's all "health insurance is immoral" effectively.
Yeah I was just piggybacking on your comment, not trying to push on your analysis in particular.
I think if you built a case that Thompson was negligent in his duties as CEO and cost lives and a better CEO would have done better, then you could have a case that he bears some moral responsibility for those deaths. But if the assertion is “if he/the system had been perfect those people would still be alive” is very dubious moral reasoning.
And why does this logic only apply to ins companies? Is there some bureaucrat or elected official in the UK who deserves to go to prison for blinding my friend’s grandmother because the NHS did not approve her macular degeneration treatments fast enough?
It's actually a bit more reasonable to be upset with the UK bureaucrat for doing a bad job because it is actually their job to make the decisions that save the most lives. Insurance companies are just there to make money. 🤷
I think the fairest accounting is that a healthcare CEO is both responsible for thousands of lives saved, and also for thousands of deaths. That's just the nature of being in a position of power and making hard choices.
Not sure it is clear a healthcare CEO is "responsible for thousands of deaths".
I mean responsible in the sense that when a doctor amputates someone's leg, they are responsible for saving the patient's life, and they are also responsible for that person not having a leg anymore. A healthcare CEO is like 1/10,000th responsible for a billion healthcare decisions. There are going to be some wins and losses involved, and hopefully many many more wins than losses.
Your point is very reasonable. When decisions are made about airlines or traffic or pollution or any sort of very broad thing, there are a handful of people who will die because of the new policy and a handful who now won't die. But you may not even be able to determine the identity of *anyone* in either group. If 2500 people get cancer versus 2400 you can't identity the 100.
If we're lucky the total deaths go down. It's all trade-offs.
PEOPLE WILL DIE https://reason.com/video/2017/06/28/remy-people-will-die/ is so often a trump card on reasonable conversation, and a lot of people will do whatever they can to avoid being accused of wanting people to die. But people will die from either choice and we need to accept that.
…Or lives. They’re responsible for ensuring that the company operates effectively, deciding what gets covered and what doesn’t is not up to them individually, a lot of it is decided by government regulation or medical standards.
This times 1,000. People act like the CEO is responsible for the entire framework that the insurance company operates within. Health care is massively complicated. The outcomes people are talking about here are driven by thousands upon thousands of separate inputs in almost every instance. Saying one CEO is responsible for almost any specific health care outcome for any individual is absurd.
They didnt make people sick, or make medicine cost resources.
Does a healthcare CEO, or any CEO, really have that much power? Don't they have to operate within stockholder constraints, embedded company culture, and threat of being fired? (In other words, no one can control a massive system like an insurance agency.)
I am really partial to the idea that no one actually has agency, and we're all just hostage to our circumstances. Isaac Asimov called this idea Psychohistory. Leo Tolstoy devoted several chapters to the same idea in War and Peace. Jeff Goldblum talks about chaos theory in Jurassic Park. You can even see a variant of it in https://www.slowboring.com/p/even-meritocratic-systems-arent-fair.
On the other hand, believing that no one has any agency leads to apathy, and apathy is bad. My brain isn't big enough to be a Calvinist and acknowledge that none of my actions matter while still trying to do the right thing. So instead I just believe that people's actions matter and they are responsible for their decisions, even though it's technically not true.
I'll take leap of faith on personal agency: it's the systemic and collective that I've always been interested in. However, my starting question has been whether institutions can act morally. Thinking about it in terms of agency introduces a different angle for me.
What is the causal basis for attributing deaths to a healthcare CEO? It seems that any deaths attributable to his decisions would be from either saving money by denying coverage for expensive treatments or from making premiums so high that people are priced out of affording them. But he has to do one or the other, and it’s impossible to know ahead of time which would cause more deaths.
I get the point you're making, but compared to the counterfactual of "we still have no UHC, but insurance companies are banned" I can't figure out who that would be better for. The uninsured would still be uninsured. I guess healthy people would save a few bucks on healthcare premiums. Maybe some guy who gets mugged would survive in this alternate scenario.
"GIMME $100!"
"Dammit I just paid my healthcare premiums! I'm out!"
Brian Thompson in this case is being used as a stand in for "insurance companies refusing coverage," I think. And the difficulty here is:
a. Some coverage should be refused because it's snake oil or fraudulent or unnecessary. Replace insurance companies with incorruptible angels and those refusals will still happen, and also these refusals make the world a better place.
b. Some coverage is refused strategically by insurance companies--they should not refuse it but do so in hopes that the patients will just pay out of pocket or do something cheaper. This is bad and we want less of it.
c. Some coverage is refused because it is very expensive relative to its benefit. This is probably the right choice (medical care has limited resources like everything else), but is a bad thing--we wish we had more resources and could cover anything useful.
You might judge a CEO or insurance company as bad for doing too much (b), but it is often hard to distinguish that from (a) and (c), and the lines between the categories are fuzzy.
Has anyone credibly asserted that under Thompson’s leadership UHG was doing an inappropriate amount of (b) that led to deaths? Even Mangione didn’t really seem to have a specific complaint with him.
I think John Roberts has spoken of limiting liability somewhere between the want of a horseshoe nail and the loss of the kingdom and this applies to Bryan Thompson as well
This goes back way further than John Roberts. It’s a fundamental principle in tort law.
Yep. I just remember reading a quote of his about the topic that I thought was pithy and germane
+1 for the general sentiment, but I don't think the question was asked in earnest. The author wrote:
> A lot of whackadoodles try to justify his murder on the basis of “all the people he’s killed”
That sounds like someone asking Matt to debunk the elementary-school logic at play.
I would expect that for any large insurer, Medicare included, you can find examples of ill people who died after being denied coverage for a treatment they thought might cure them, but that their insurer determined was experimental or of unproven efficacy or otherwise a waste of money.
The frontiers of medical technology are always changing and that means there will always be arguments at the edges over which specific treatments are considered standard and essential, vs extra, elective, experimental, or otherwise justifiably not part of the standard package. Today's experimental treatment might be tomorrow's essential care, or not.
The question is how and by whom should those decisions be made? Medical providers have expertise, but also have a conflict of interest, in that they're inclined to err on the side of paying themselves more. Nonmedical finance type overseers have their own conflicts, etc.
Slight caveat, I think most people who work for health insurance companies do probably think if themselves as doing something positive, and per my other comments, I think on net they are, but "provide medically necessary treatment to the best of your knowledge at the time" isn't QUITE the incentive medical insurance companies have. Unless directly prompted by the government, medical insurance is kind of indirectly a consumer product. It will cater to what consumers want and are willing and able to pay premius for (or rather, what their employer is usually), which is not always the same thing as medically necessary.
Agree, except would say that the term "medical necessity" should be understood as not so much a medical technical term of art, but as a commercial term -- what package of treatments do customers in the market for health insurance generally expect to be included standard, and what can feasibly be included without driving the price so high that nobody wants to buy the policy. In France, apparently, a nice stay at a thermal spa can be considered medically necessary, i.e., part of the standard package of medical treatments that people expect to have access to.
I've clumsily tried to make this point before and you're the first person to understand what I'm saying, so thank you.
Of course if we were drafting a universal coverage plan from the government, we'd probably want to give a more critical eye to "medically necessary."
If you’re in the business of making life-or-death decisions, then almost surely you’ll be making some decisions that cause people to die and others that cause people to live, and very often one decision is going to cause both. You can be doing net good for the world even if there are people who die because of your decisions who wouldn’t have otherwise.
With a medical insurance claims adjuster, it’s probably single digits of lives, and with a medical insurance executive it’s probably in the hundreds of lives, but if you’re a legislator it’s probably in the thousands of lives, and sometimes tens or hundreds of thousands when you’re looking at air pollution legislation or car safety or the like.
The funny thing is, if I'm coming across here as a defender of the American healthcare system, I'm really not. I'm just defining the roles here. The job of an insurance claims adjuster is to pay out as little as possible while still providing the minimum amount of coverage that people are still willing to pay premiums for. Their incentive is not to save lives. I'm not upset with them about that, they're doing their jobs. But it's also true that the existence of the insurance industry pretty obviously saved thousands of lives, even as imperfect as it is if the alternative were just "no insurance" which the Luigi defenders seem to be implying would be preferable.
I remember a great Cautionary Tales podcast about this issue (it's been a while, so I'm almost certainly about to get some details wrong, so I apologize in advance). A man in England lobbied tirelessly o receive an experimental treatment that was denied by the NHS as being too costly and not likely to be effective. He thought it would save his life and he portrayed the NHS as bean-pushers and spreadsheet slaves who couldn't understand the importance of just approving this treatment and saving him. My recollection is eventually the public outcry led to changes that allowed him to get the treatment, and that it essentially made no difference and he died anyways.
The effectiveness of changes implemented to the NHS to cover the costs of these experimental treatments is, as I understand it, highly contested at best, with significant reasons to be skeptical that it's done anything other than drive up costs while providing little to no benefit to patients. It's just true that wishful thinking is pervasive within the patient community, and doctors who get paid for it are not highly incentivized to discourage such attitudes. It therefore often falls on number-crunchers to actually analyze the data and determine if a treatment is cost effective and reasonable to pursue.
The notion that it's greedy insurance companies that are causing the health and wellbeing of Americans to suffer seems wrong to me, but the uninformed will always find them to be an easy target of their ire. It's very unfortunate, especially when such attitudes literally result in a husband and father being gunned down on the streets.
I'm extremely sympathetic to the sick people fighting for any chance, even a slim chance, if it means they could get better, but the system as a whole cannot operate from the perspective of individual patients.
I think most other systems do a better job of hiding the technocrat making yes/no decisions on coverage. If you're a doctor and you know X isn't paid for in your country, you tell the patient there's nothing to do, and everyone goes on with their lives [1]. Knowing that X exists and is being *denied* to you is much worse. (Even if X would, in the end, have negative outcomes for you regardless of cost.)
[1] except for the person who dies
I will just add that denying some of these unproven or experimental treatments may be in the patient's best interest. Avastin was conditionally approved for metastatic breast cancer in the US based on an increase in progression-free survival. The UK refused to do so and was accused of murdering breast cancer patients. When the more comprehensive studies were done, Avastin did not prolong life. It was associated with a much higher rate of adverse effects and women had fewer "good quality" days of life. I can't remember if it ended up decreasing the survival time. It's now no longer approved for metastatic breast cancer in the US.
There was also the scandal of women with metastatic Breast cancer undergoing high dose chemotherapy followed by autologous bone marrow transplant. It was a huge to do about insurers not covering it because it was experimental so we finally did a study and it turned out it wasn't effective and one of the earlier studies showing a benefit was faked.
United Healthcare adopted a stricter definition of sepsis during covid, which confused hospitals and resulted in the denial of many legitimate claims.
I think in this specific case the questioner is on solid ground. Thompson isn’t just any healthcare executive and UHC isn’t just any insurance company.
UHC’s claim denials and shrinking coverage were, well, skyrocketing and we have pretty good evidence they were committing Medicare advantage fraud (see the wsj series on Medicare advantage). They are, or were, a criminal enterprise and the decisions that drove them there were made by executives, one of whom was brian Thompson.
No one at UHC was going to go to jail. We’re probably talking about a settlement at the DOJ. And, frankly? That’s not just nor a deterrent to it happening again. We shouldn’t be surprised someone did something extra legal. And we need to change the laws and ways in which we prosecute crimes in this country so that people who commit this kind of fraud go to prison.
I don't think this is responsive to the question, which is how many deaths was the CEO responsible for.
There is no "deny fewer claims but only the ones that will save lives, not the speculative expensive ones that don't help" policy lever. To a first approximation, there is only a "deny fewer claims" lever, which mechanically raises prices or reduces insurance coverage, and causes more deaths.
By all means, prosecute fraudulent healthcare executives instead of electing them to the Senate. But the question was on the potential justifiability of the murder of the CEO, and the idea that "the questioner was on solid ground" is the road to anarchy.
It would be one thing if UHC had done that. We’re not talking about marginal experimental treatments here.
UHC engaged in a willful strategy of pulling back coverage (abusing firm lock in), and abusing the prior auth system (ask any doctor about who suddenly became the worst HMO to deal with like magic 3-4 years ago) to cut costs and engaging in Medicare advantage fraud. When you suddenly require a prior auth for generics and make every doctor do 3-4 peer to peers by default, people are going to have questions.
Brian Thompson, and the executive team, should have gotten 25 to life if they willfully engaged in this strategy.
I have a feeling that Luigi Mangione murdered the CEO of Aetna or Cigna or whatever then people would still be justifying it.
If MAGA can have their antichrist then Leftists sure as hell feel entitled to their own.
"(ask any doctor about who suddenly became the worst HMO to deal with like magic 3-4 years ago)"
Having seen how much the same procedure might be charged in Europe and the US, I very HIGHLY doubt that the insurers rather than the doctors are the guys who make healthcare less accessible here. Sure, Americans earn more than Germans on average, but American doctors earn MUCH more than German doctors on average. Still, I do NOT believe that people should think "My dear doctor, you want your annual income to be how high??? I will murder you.".
Advanced neurosurgeons in the UK make about $100k/yr lol
Not sure what “advanced” means but that sounds exceedingly modest, at least by American standards.
That sounds reasonable. I would expect British salaries to be above the EU average. But yeah, if the insurance company denying claims is responsible for people dying, what are the doctors who ask for American salaries responsible for?
HCA is the largest for-profit operator and surprise surprise their stock price is up and to the right: https://finance.yahoo.com/quote/HCA/
Because of course it is. If it's not everyone gets fired.
I was not suggesting that his murder would be justifiable if the answer were high. I was suggesting that the people who actually do justify the murder are doubly wrong: first because murder is wrong no matter what someone has done and second because Thompson hadn’t done anything that could justify his murder even if you disagree with the first point.
The question is challenging because of course anyone being murdered is wrong. It's really hard to have a needed conversation on prior Authorizations and the big insurance problem. Might be a good evening review for Halina.
"extra legal" is doing a lot of work to avoid condemning murder.
No, extra legal, as in really legal!
No, money down!
I doubt whether the Medicare Advantage fraud killed people; the decision to deny a much larger fraction of claims than competitors probably did, but it’s hard to say how many. I am curious if you have any idea what the corporate thinking was there, though—like Matt said, you can only get your medical loss ratio so low before you have to start rebating premiums, so “collect money for insurance and never pay anything out” has some real limitations as a strategy. So was it an epiphenomenon of trying to get the overhead/combined ratio as low as possible? Did UHC decide that “no coverage and maximum rebates” was the ideal way to take advantage of the principal-agent problems that come from America’s ridiculous employer-provided insurance system? Did a fortune teller tell Brian Thompson he wouldn’t see any legal or financial consequences for doing this and he said “YOLO”?
"you can only get your medical loss ratio so low before you have to start rebating premiums"
Rebating premiums isn't the only way to get your medical loss ratio down, as an ACA-regulated insurance company. You can also buy up a brunch of healthcare providers -- physician practices, pharmacies, etc -- and then steer your insured patients to them, and have them charge your insurance arm higher prices so that you capture the money on the other side. The left hand pays the right hand, and the medical loss ratio stays where it needs to be.
This tracks, see UHC/Optum and CVS/Caremark
Medical-loss-ratio is cost-plus pricing by another name.
Without seeing UHC docs we’ll never know. It’s been received knowledge since the 80s that basically all insurance is run by idiots who can’t model out second order effects, and yes are that stupid.
The finance industry is only discovering that in the past decade, after economists discovered this a year before that. Insurance job talks are fun because it’s always “I know it looks dumb! I know! Are they stupid?!.” Most often this is LTC and life where you can get data, but my work with pharma with data that will never come out suggests it generalizes.
This all goes back to the FTC being banned from looking at any insurance after discovering a lot of annuities were scams.
Agreed. I think it is a reasonable question, as UHC's claims and denials were about double the industry average, and a good-faith answer would take this into account. The real question is whether there is a marginal increase in unnecessary deaths due to claims being denied. From there, you could logic out how many claims were being unfairly denied by UHC and come up with a number. I'm not an expert, so the answer may be zero, and it may be more than zero, but it is a reasonable question ot ask.
I don't think any answer to this question justifies vigilantes gunning down people on the street. I also don't think it is satisfying to just shrug, say it is an unknowable system, and walk away.
If a hard hat were purposely designed to fail industry standards twice as often as a cost-saving measure and the results were clearly borne out in statistics, wouldn't you expect there to be consequences?
There is no possible way that UHC claims and denials were double the industry average. Wherever that number came from, it should be debunked. And besides most “denials” in insurance are incorrect codes that are later corrected and paid out. Less than 1% of claims are in the end denied. Hospitals love to game the system and code for things that didn’t happen or pay more. Likely UHC is just better at catching those instances.
The strangest thing about all this is the real “murderers” are the doctors and hospitals who refuse to administer lifesaving treatment unless they can be more reasonably be assured they will get paid. A bit odd to blame a health insurance exec for a hospital going “sorry, I could save your life, but I need to eat too”. This is obviously hyperbole, but a hyperbole that makes more sense than blaming health insurance companies who simply pass on higher costs through premiums. It’s really no skin off their backs to collectively ok every treatment if they keep their medical loss ratio stable. Ironically, while this has been going on health insurance companies had the highest medical loss in the post Obamacare era.
1. You're almost certainly correct that UHC doesn't deny at twice the industry average
2. I think you might be conflating payer/clearinghouse rejections with payer denials.
Having worked in the insurance industry, you are correct about the denials. There are a lot of denials that occur because the claim is not billed correctly. Codes that should be bundled are submitted non-bundled. Then there are the claims that are submitted too late. Some error caused a provider to miss a bunch of services when they were sending claims and now it's too late. I constantly see articles on how terrible an insurance company is for not paying some patient's claim and it turns out that the provider billed it incorrectly, in some cases in ways that would be considered fraud if it was sent to medicare, and yet it's the fault of the insurance company not th provider who didn't bill correctly.
This is my source. I’m happy for you to debunk it but the same chart is in a few places including the Boston Globe. https://axenehp.com/health-insurer-claim-denial-rates-kaiser-outlier/
To start with, there is no source for the chart and the author doesn’t even know if it’s legit. As far as I can tell the only info available is for healthcare.gov which is what, 2% maybe 3% of the total marketplace and where this chart info comes from most likely.
And do we really think over 30% of claims are being denied? That’s total nonsense. I have a bunch of kids, many family members and I’ve never even heard of a denial beyond some dumb mistake that the doc or the insurance company fixed. What matters is real denials in terms of damn, that seems like it should be covered and they are straight out saying no. Those are very rare and probably most often admin errors. The ones that aren’t errors are edge cases where insurance says hell no we aren’t covering this because we aren’t sure it works and it will drive costs up and profits down. I don’t blame docs and patients for trying but you really want someone in the loop saying no.
For instance the story going around was Luigi got denied for a back surgery for spondylolisthesis which, the evidence shows, is not something surgery helps with. Still doctors recommend it especially in certain parts of the country. Should insurance deny it. Yep, probably.
Almost every insurer on that chart is above the industry average.
I'm really curious which insurers are bringing that down?
Kaiser brings it down some, but Kaiser is specifically an HMO that does treatment & insurance - they're not going to get many "wrong coded" claims. (The article also covers this)
UHC does seem high though.
Kaiser might just be an overwhelming number of ACA plans for whatever reason.
UnitedHealth's public submittals show a 90% approval rate.
ACA data- the source for that chart- is at 33%. UHC claims that’s “unfair” and gives us their own number. I dunno, I’m not disposed to think of UHC as reliable narrators here, or at least much less reliable than government data.
Anecdotally at Hopkins and Medstar their denial rates are extremely high. Pulling from other public negotiations, you get even higher numbers spiking after 2022- https://www.wweek.com/news/2025/02/03/unitedhealthcares-denial-rates-slow-payments-hamper-talks-ohsu-says/#:~:text=A%20peer%2Dto%2Dpeer%20denial,of%20negotiations%20came%20to%20naught.
54% denial driven by prior auths.
> Wherever that number came from, it should be debunked
I'm pretty sure Noah Smith wrote about this, or at least some other big substacker, and the IIRC the answer was exactly as you say below -- this number came from *nowhere at all*. It's flagrantly made up.
“doctors and hospitals who refuse to administer lifesaving treatment unless they can be more reasonably be assured they will get paid.”
Doctors in hospital settings have zero idea what your insurance is or whether you’re insured at all. That’s not their purview. They’re salaried, so they get paid regardless of whether you’re insured or not. They are not denying lifesaving treatments based on whether you can pay. If anything, they’re far too oblivious to whether patients can afford their recommended tests and treatments.
Hospitals are a different story, but they’re not allowed to deny emergency treatments. They also get stiffed on a a huge proportion of their bills, so if they’re trying to weed out who can pay, they aren’t doing a great job of it.
The person in the billing department at your doctor’s office who knows how to do proper coding for each insurance company is worth her weight in gold.
UHCs Prior auth and peer to peer practices got so bad John’s Hopkins walked away from them. Just refused to negotiate.
There’s a lot of saber rattling during these negotiations but never have I seen that. UHC was making people to peer to peers for almost everything- for my wife, a hematologist, it was for generics and clotting factor that’s been around since the 90s. For our oncologist friends, it was basic chemo. For our friend in anesthesiology, they were denying stuff after operations. Like, Hopkins will deal because they eat bitterness. They are assholes wrapped in an asshole flavored pastry, they love to fight. But these denials are probably killing people in other areas (deadweight loss, waiting for care) in oncology alone.
" Like, Hopkins will deal because they eat bitterness. They are assholes wrapped in an asshole flavored pastry, they love to fight."
Almost as much as they love William Osler?
“…UHC isn’t just any insurance company”
Sure it is. I’ve had their coverage, though my employer, for two years now and going on the third in January.
I haven’t died yet.
Selection bias. If you had died, you wouldn't be tell us here that you did.
Survivorship bias, surely.
I also didn’t die last year.
See the pattern?
They turned Ken into a newt!
Tough chance of that when we have Mr. Pardon 4 Bribes in the White House. The only way we are getting more prosecutions is if it can somehow be turned into a financial benefit of Trump.
Was Luigi Mangione even aware of the accusations of Medicare fraud?
A basic rule of parenting or management or any kind of negative consequence is that there needs to be a connection between the crime and the punishment. No other health executive CEO is going to worry about being murdered because they commit Medicare fraud. They'll probably start taking a private car everywhere, though, instead of walking on the street and using public transportation like we want our elites to do.
I can tell you that after this all happened, UHC decided to deny coverage retroactively to someone I know, after over half a year and 300k of cancer therapy, after having previously approved all the care. They claimed that this person was eligible for Medicare.
Of course, they could have denied the coverage before that work was done, or just simply not approved all this work that they gave pre-approval for. That would have given her the ability to sign of for Medicare in time.
But instead, they decided to put someone who was covered by their insurance, going through chemotherapy, on the hook for 300k.
Of course, political violence is NEVER okay, and neither is glorification of terrorism.
But, on a completely separate note, UHC is a particularly bad actor.
What your friend went through is terrible, but the blame doesn't (solely) lie with UHC. Medicare coverage starts at age 65, and your friend should have received notification. I believe they should have still been able to apply for Medicare and cover up to six months of past charges (if Google is to be believed).
Here's an example of a similar (or the same?) case: https://www.reddit.com/r/HealthInsurance/comments/195d48b/health_insurance_decided_to_retroactively_drop_me/
No the person is below 65.
This is Medicare eligibility based on disability.
I think there's a common assumption that denials juice insurance companies' profits. But with the medical loss ratio being a minimum of 85% for large insurers, I assume they are all operating right at the edge of this (I remember getting a check once in 2012 when my insurer underestimated). Why do we not put some of the blame on the greedy doctors requesting more and more unjustified medical care?
edit: I see others hit upon this point below.
A claims denial leading to death is the exception, not the rule. There is no sound case for violence being justified here.
Having gone from BCBS to UHC and back to BCBS in the last 5 years, I can way that UHC was significantly harder to deal with and seemed to deny claims without justification.
I'd like a law mandating that all insurers disclose the % of successful appeals annually. That would show who is denying care inappropriately. A Kaiser Foundation study found that, in medicare advantage plans, the highest rates of successful appeals occurred with Centene, CVS, and UHC. Other than Kaiser, appeals were successful between 70% to 94% of the time, indicating that many claims denials are inappropriate (although this is influenced by selection bias as only the most justified denials get appealed).
Interestingly, the appeal rate (% appealed) was inversely correlated with the number of prior authorizations required per enrollee. UHC had a low PA rate, but high appeal and success appeal rates. Hard to know how much of the PA rate was policy versus mix of patients.
https://www.kff.org/medicare/nearly-50-million-prior-authorization-requests-were-sent-to-medicare-advantage-insurers-in-2023/#:~:text=Table_title:%20Use%20of%20Prior%20Authorization%20by%20Medicare,%7C%20Share%20of%20Denials%20Appealed:%203%25%20%7C
"How many deaths could reasonably be attributed to Brian Thompson?"
I'll answer it. Fucking zero.
Well argued - love the attention to detail and reliance on available evidence.
I'll take my likes but a foundational rule of the internet is don't feed the trolls. Matt did here unfortunately.
Yeah, this is a very dangerous road to say someone can be killed by extrajudicial means because of 2nd, 3rd or 4th order effects. And I say this as someone who thinks that Brian Johnson can be reasonably called a particularly loathsome CEO even compared to other Health Care executive CEO for reasons laid out by the commentator "Jimmy Hoffa". In general I think the bar needs to be extremely high for extrajudicial killing to be justified; it's one of the reasons I have huge issues with "Stand your Ground" laws (at least as written). But if you can kill someone under the idea that "due to second, third, fourth order effects" you're responsible for someone's death, then basically all of us can be justified to be killed by climate activists under the idea we all contribute to global warming and global warming has very likely killed thousands of people.
Meh, if it had just been the Express Scripts guy it’d have been justified
First, global warming is obviously going to kill many orders of magnitude more than thousands of people. Second, the relevant question from the standpoint of trying to justify the CEO's murder (or polluters' for that matter) is whether the one killing will save many future lives. It's not hard to find hypotheticals that accomplish this (e.g., baby Hitler examples), and it does not matter logically that the effects are distant from the cause. The difficulty with the question is that it supposes there is a justification for past deaths (not clear if this is meant as a moral or a legal justification), which the CEO murder obviously cannot prevent.
Every time I see these pictures glamorizing Luigi Mangione I throw up a little in my mouth
You'd probably see fewer of them if he looked like Donald Trump minus the make-up...
Or like the guy who tried to shoot Trump.
I have had insurance with three different companies now, and UHC is far and away the worst. I have had nothing but extremely negative experiences with them all around in pretty much every arena possible, from the website having inaccurate information, terrible customer service, and all the way to *several* unjustified denials (later reversed but only after I spent hours fighting with various people on the phone). I am strongly considering leaving my employer and no joke the #1 thing I will ask about benefits before accepting future job offers will be who the insurance provider is, and you'd have to pay me a hell of a lot of money to ever put up with another UHC plan.
But at the end of the day, extrajudicial murders are, in fact, bad. Even if the company was somehow 100x more evil to the point that it might justify some kind of criminality, 'assassinating the CEO' is simultaneously one of the least moral *and* least effective acts of political terror you could commit. If we are suddenly justifying killing people for providing a poor product relative to market competitors I feel like one could come up with quite a few guys that should be higher up on the list.
To be clear, I have been arguing with people justifying Thompson’s murder for almost a year now on the basis that murder is wrong, but it only just occurred to me to challenge the underlying assumption that his management decisions led to many people’s death. I asked the question to ensure that I would have a reasonably strong factual basis for making that argument.
Interesting, but I think the better question is whether the CEO's murder can be morally justified on the ground that it avoided future deaths by ending that CEO's policies or practices that would have caused future deaths, and/or convincing other insurers to change their policies or practices that would have caused future deaths. If either of these suppositions were true and could be proven, it would provide a sound utilitarian moral justification for the murder. But neither past deaths nor avoided future deaths can provide a sound legal justification for the murder. Past deaths can't be used as a ground for the "defense of others", and the link between CEO-driven policies and possible future deaths caused by those policies is too tenuous to fit the requirements for that defense (remote in time and place, etc.)
Not to mention there is precisely zero reason to believe that the system that gave us the CEO that was murdered won't simply replace him with another CEO that will have the same motivations and lead to the same or similar outcomes.
I think that Mangione is a monster and I want him to rot in jail the rest of his life, and the people who support him are also horrific human beings. But even if you agree that they're right about how awful the CEO was, his action is still horrific and useless based on the fact that it doesn't address any of the causes of the things he claims to care about.
I agree that there is no reason to believe the CEO's murder saved any other lives. Mangione seems mentally disturbed and morally confused, so that at least makes him very dangerous, if not "a monster"
A technicality I would dispute. Someone's mental disturbances and moral confusion may be the reason they are, in fact, a monster. Shooting a husband and father in cold blood because your politics and morals are ass-backwards is not incompatible with being a monster.
Right, but "monster" implies an involuntary and immutable state of being. I don't know that much about Mangione, but if he got the right meds and that allowed him to realize that his actions were gravely wrong, then he would cease to be a "monster".
When people are talking about moral desert, they’re concerned with the moral character of a person’s past actions, not necessarily what harm ought to be visited upon a person. It’s perfectly sensible to have a discussion about the former distinct from the latter.
Discussing moral desert for past actions is really just time-traveling the hypothetical to a point in time prior to the past actions. It asks "should he have done the thing" that caused the harm that could have been prevented if he hadn't done the thing, or "should he have been prevented from doing" the thing he did that caused the past harm. So the analysis is exactly the same: if preventing the past action would have prevented the (greater) harm the action caused, then there would have been a sound utilitarian basis for preventing it.
As it happens, there are other moral philosophies besides utilitarianism.
Certainly true, but they all evaluate the "moral character" of an action based at least in part on the harm or benefit it produces it produces.
It's not really "scary", it's just straight-up utilitarian logic: if killing one CEO will prevent more than one future death by avoiding lethal denials of coverage, the action is net beneficial. The factual premises are almost certainly wrong -- including the assumption that the current CEO has anything to do with coverage denials, or that the next CEO will deny coverage less, but the "outlook" is one that takes life-saving seriously, in the grand tradition of a million utilitarian thought experiments.
“…straight-up utilitarian logic”
Utilitarian logic is not a sound basis for moral reasoning.
Utilitarianism IS a system of moral reasoning, and may be the most intellectually defensible one among the available candidates. Far more so than religious doctrines or deontological systems, many of which ultimately resolve into utilitarian / consequentialist assumptions on further inspection.
It just tends to lead us in places the monkey brain finds uncomfortable or at least quite strange (Bentham's Bulldog being even weirder than Jeremy Bentham himself).
I agree that most of the time most people would prefer to act like monkeys than to think deeply about what they are doing. It's a long-standing problem for the discipline of philosophy as a whole.
I would not only throw out the question--I would refund the questioner his subscription.
I feel like we all read two different questions. How are you guys reacting this way? Did you read the question? The questioner is obviously not taking this position, he's offering up the logic for Matt to attack it. I think that's kind of a lame sort of question to ask (this place has enough left-bashing as is without poking Matt to do more of it by posing an argument you don't even believe in), but if you read the text of the question I think it's fairly obvious the questioner does not, in fact, support the assassination of Brian Thompson.
He clearly does not support the murder and thinks that line of justification is very dubious. I’m gonna assume people here just hadn’t had their morning coffee.
It wasn’t about offering up the logic for attack, it was about gathering information about the factual premises. Boiled to its essence the question is “how often does an insurance company’s denial of coverage actually lead to death in a given year, and was UHC on the high end of this range?”
If the actual answer was “less than you’d think but probably at least a few hundred”, I wouldn’t raise this point when people try to argue that Thompson’s murder was justified. If the answer was “none” then I would.
Sometimes I wonder if some of these questions are designed to get Matt to write things that allow his critics to bash him from the left. They want some quote so they can say “Matt Yglesias thinks it’s cool that insurance companies deny people coverage, even if they die because of it.” I also wonder if Matt, aware of this, writes responses like today’s in order to deny them an easy quote.
Conspiratorial, but depressingly plausible.
Give the questioner three lashes with the cane!
Are we not also trying to quantify all the time how many deaths elon is responsible for?
If Luigi had been worse looking, he wouldn’t have been martyred. People just be thirsty is all
Absolutely. Who lionizes Thomas Matthew Crooks, or indeed remembers him at all except for "what if Luigi was ugly" comments like this? Justified or not, what he tried to do was a lot higher-stakes than what Luigi did.
I had to look him up lol
Only 6?
“over and above the more general wrongness of murdering people” doing a lot of heavy lifting in that answer.
I have seen people claim that Brian Thompson “killed millions of people” and it never occurs to them as to how this can be true in a country with 3 million total deaths a year.
These people are just lazy epistemological nihilists who want to revel in violence and evil.
It's quite easy for incurious people to go through life with no real understanding of the scale of anything.
Late Stage Capitalism = copout for people too lazy to learn how systems work
Anytime I hear the term late capitalism, I know that person has no real policy suggestion. Also they're the last people you want running anything.
When I hear “late capitalism” I just go “that is a dated term.”
Or “we’ve been in ‘late capitalism’ since 1848.”
I think we are currently going through like the fifth broad systemic transformation of capitalism since it was originally dubbed 'late stage capitalism'.
This is just Laterererer Stage Capitalism
Any day now, Dan, capitalism will totally collapse!
That’s why I just tell these people, “all you are communicating is that you don’t even care about knowing.”
I'm biased as an engineer because "understand the scale of things" is basically the only marketable skill I have.
If you can only have one skill in life, you could do a lot worse.
I mean, how much is a million, anyway? That’s why I proposed we swap to metric prefixes. There’s no way Brian Thompson caused three megadeaths.
Especially when you consider how big a deal Covid was and that caused over a million deaths in the US. If a single insurance company was causing genocide-level death in this country, it would be pretty obvious.
Hah, this morning I was thinking that “how much is a million anyway?” is a reason specifically *not* to switch to metric.
Quick quiz question - without calculating, do you have any sense whether a megasecond is more or less than a year?
Being able to say that something is a megawatt or a megajoule makes it *sound* like you know how much it is, but it doesn’t give you the understanding you actually have if there’s a natural unit in the vicinity. You can understand how long a duration is if you measure it in years or days or seconds, but if you insist on measuring it in seconds and kiloseconds and megaseconds, you don’t really understand how long it is (though you can easily calculate some ratios).
Quiz answer: an hour is 3600 seconds, so a megasecond is just under 300 hours, which is about two weeks.
I've noticed this effect with metric usage outside of scientific settings. Metric users frequently throw away the useful prefixes of metric by saying things like "2,500 kilometers" to stick with a familiar unit rather than "2.5 megameters." "Tonne" is a particularly hideous example.
Even nuclear scientists don't quote the weapons' yield in teragrams. What happened to consistency, people?
Fun fact, pi E+7 is really shockingly close to a year!
Yes, I learned the mnemonic, “pi seconds is a nanocentury”!
lol yes I knew that one thanks to Vernon Vigne and A Deepness in the Sky where there are kilo seconds and mega seconds galore.
iirc my original proposal was purely in terms of money. We were all discussing how hard it is to wrap our heads around trillions of dollars or something like that. imo we'd run into problems with very large numbers of any kind because we're just up-jumped monkeys with all the cognitive setbacks that entails.
How many Megadeths does the world need anyway?
To be fair(?), there's very likely a large overlap in the circle of people who believe Brian Thompson “killed millions of people” and the circle of people who believe American law enforcement kill 10,000+ unarmed black men each year.
It was a good decision to repeatedly use the word "believe" rather than the word "think".
And they want everyone to think they are somehow morally superior because they can repeat lazy nonsensical fictions too. Especially when they are advocating for… wanton acts of violence.
See also the "kids can't do math" discourse yesterday
Yet chickens can.
He was CEO for 3 years and worked at UHC in other executive roles for almost 17 years before that. If he started his killing spree as soon as he joined UHC in 2004, and "millions of people" means at least 1M, then he would have had to have been responsible for 1M deaths out of the 32M deaths that occurred in the US between 2004 and 2023, or 3.1% of all deaths.
But this good news is just in from Chat GPT 4.o mini in response to the question "when was Brian Thompson killed?":
"As of now, Brian Thompson has not passed away. He is currently serving as the CEO UnitedHealthCare. If you have any specific context or event in mind regarding him, please share!"
1) I don't know how to break it to mini;
2) I am so grateful we are maintaining our AI lead over China....
4o mini??? i honestly didn't realize models that old were still available to use. that's like an 18 month old model! in AI time that's practically a century
Fair
Need-for-chaos Tik-Tok-addled knee-jerk populists
Im curious how many people ACTUALLY think that. This seems, to me, like an online thing that maybe 1000 people believe in the whole country that got blown out of proportion due to the internet
> and it never occurs to them as to how this can be true in a country with 3 million total deaths a year.
Just count the abortions.
I feel for you if your algorithm is serving you up that pile of ...
Na, just lived in Baltimore when this shit went down.
The voters' preferences on corruption would lead to an even lower-quality professional political class than we have today. The sample wants robots that are willing to submit timecards, take drug tests, and do "what most people want", even though in the aggregate the public's policy preferences are incoherent. At a deep level we seem to have the quality of government we deserve.
Taking drug tests honestly doesn’t seem unreasonable to me. Lots of well compensated career professionals are subject to drug tests (military officers, pilots, etc). If the compensation is appropriate, additional oversight won’t deter quality candidates. The real problem is we can’t raise compensation (or at least our representatives believe they’ll be penalized for raising compensation)
I'm trying to figure out how this would work in practice. Presidential candidates used to release their tax returns, and then Trump didn't, and nothing happened. Would drug tests work the same way?
If a politician tests positive for drug use, what happens? Is it purely informational for the voters? Would they be expelled by their relevant legislative body? Would refusal to take the test result in expulsion?
Great question, you beat me to it while I was typing the same thing. There's also ratfucking opportunity there in trying to spike a test of members of the opposition.
Don’t let them file to run again if they refuse to take a random drug test as administered by an independent agency. I don’t think they should be immediately fired for pissing hot, but it seems fair to provide the results to the public to evaluate in the voting booth. If they’re happy with the results from their cocaine snorting representative, that’s fine.
We should make submitting your taxes a requirement to file too while we’re at it; the problem was that was never actually a law, just a norm.
All tax returns should be public record anyway
Informational - you can't add random qualifying pre-conditions to the bare Constitutional requirements for office holding (unless you amend the Constitution). Article 1 does allow each chamber of the Congress to expel members for "disorderly conduct", but it requires a 2/3 vote of the body for removal, so removal for drug use could not be made an "automatic" sanction without (another) Constitutional amendement.
We write a law that forces politicians to take drug tests and removes them from office if they fail or refuse. Same thing we would do for any politician we discover has committed a crime.
As Joe said, it’s unconstitutional to attempt to overrule a Congressional (say) election via an ordinary law.
And almost zero jobs in executive sectro require drug testing - pilots and military staff are not comparable to legislators.
Why the fuck would one make being legislator even more of an unappealing path (except to grifters who will play along)?
What possible gain from drug tests do I get? Knowledge a legislator gets drunk or high? so the fuck what?
My last two desk jobs required drug testing prior to hiring, it's pretty common in manufacturing.
I would only support drug testing legislators to have them go to the same facility I did just outside the Beltway in Maryland, so they could sit in the same waiting area I did for an hour among a segment of the population they really never interact with. Let them deal with a jaded staff that has seen every way to cheat the test, and applied policies to prevent it, or just have to take time out of a busy day to do this, and maybe lawmakers will think twice before suggesting drug testing as a benefits requirement or legal punishment.
Forcing people to use the systems they run once in a while is valuable. But drug testing politicians for the sake of the drug testing isn’t very valuable.
"If I have to piss in a bottle to drive a bus, the President should have to piss in a bottle to launch nukes."
With aging male Presidents, that might take too long to respond to an incoming threat in time...
There’s some historical evidence to suggest Richard Nixon was drunk while weighing the decision to launch a nuclear strike against North Korea following their attack on a US reconnaissance plane in 1969. If true, I for one would have liked that information to be public knowledge during the 1972 campaign.
Churchill was frequently drunk throughout WWII. And he was brilliant.
So the fuck what.
Prissy teetotalism is sterile. (and no I am not a drinker myself)
This leaving aside entirely the utter uselessness of scheduled tests to detect something like what you cite - unless you ahve the fucking sobriety tests all the fucking time as if they're going through DWI checkpoints
You don't have them all the time and you have them scheduled well in advance. Can people get around that by just being sober for three days before the test? Absolutely! That's the point. You're screening for people who can't even do that.
Sucking up to donors is way more humiliating than peeing in a cup. It's weird that this is a hill people are willing to die on.
Hill to die on?
It's just an obviously stupid idea, a waste of time and resources and serving no function beyond generally prudishness.
Bad idiotic "reforms" layering on more requirements, more bureaucracy, more procedures is half of what got the Left into the idiotic bind it is in, along with prissy secular moralising.
(and do read for detail - "detect something like what you cite"- i.e. Nixon supposedly being intoxicated while deciding on N. Korea)
"Churchill was frequently drunk throughout WWII. And he was brilliant.
So the fuck what."
Putting the function in functional alcoholic FTW!
Do you know how drug tests work, though? They don’t detect alcohol.
Not just a general drug screen but adding an alcohol screen (well, ethyl glucuronide) is dirt cheap and widely practiced, just not for pre-employment
I’m aware, I was making a general point about mind altering substances and their impact on decision making
We have had three self-proclaimed straight-edge Presidents in recent history: Bush 2, Biden and Trump. I too think it's important to know which candidates have the mental fortitude to handle their booze.
Before one of the debates, we really should ask presidential candidates to get liquored up to a BAC of .12 so we can see how they function when they’re right in the slot
I'm back at the assumption that they would perform better sober than high -- not at all clear to me. Opinion may be based on the public's annoyance that they have to take drug tests for many jobs but legislators don't. But in that case, the starting point may be the application of any health, safety and non-discrimination laws which don't apply to Congress.
Those are careers where you are doing physical labor that requires a high level of coordination which could be impaired by drugs, it would be silly to require drug tests for a high-level desk job like politician.
There are a lot of desk jockeys in the military taking drug tests. We test them (at least in part) because they’re responsible for making life or death decisions, not because of the physical requirements of the job.
We test them primarily because there's no appetite for distinguishing between roles where it matters or doesn't matter, and drug testing in the military itself is mostly an artifact of a different era and view about the war on drugs.
Military.
Now think about that.
People in the military have agreed to a lot more loss of privacy and individual liberty than pretty much anyone else. In what other job can your boss order you to do something that will get you killed and then have you executed if you refuse?
Why shouldn’t politicians have to agree to the same losses in privacy and liberty as the military?
Not saying that I’m pushing for congressional drug testing, but I find this argument thoroughly uncompelling.
Why are we trying to make being a politician more annoying so that desire for payola as a reason to go into it is higher?
There’s a strong argument that that level of discipline is necessary for the military. If you want to make a comparable argument for politicians, go ahead, but do it on its own merits, not by comparison to the military.
If the point was ensuring they’re not on drugs at work, then it should be random on-the-spot drug tests. What’s the point in learning that someone in one of these jobs sometimes takes a drink or gets high on a Friday night?
(You cannot learn that someone sometimes drinks on a Friday night with drug tests)
Nor can you tell if they do cocaine on a Friday night! Drug tests are good at telling if someone *ever* does cannabis, and good at telling if someone is *currently* on alcohol or cocaine, but it's not clear what connection they have to job functions under any of the ways they are usually used.
Absolutely correct
Test for what drugs? Given the age of so many members of congress, I assume a large percentage of them are taking about half a pharmacy rack on any given day.
Presumably the same you test for in a normal drug scan. Mostly illegal drugs. Congress should abide by the rules it creates for citizens.
Citizens don’t have to take drug tests.
The public probably deserves to know what prescription drugs their representatives are taking too
You've just created basically no incentive for anyone to ever run for office again.
Making the job of being a congressperson painful selects for zealots and rich guys. The zealots don't care if their life sucks, and the rich guys can pay to make their life not suck.
Taking a drug test is not painful. These people are inherently public figures and will have their life inspected from every angle; a drug test is not substantially more invasive than having journalists comb through your digital footprint for the comments you’ve left on porn sites. I agree, we should compensate congressional representatives to the same degree we compensate senior managers in private industry at least. But public scrutiny is part of the job
Zealots, rich guys, and grifters, the grifters being willing to put up with some suck for as long as it takes to get their bag.
Pilots are drug tested, as are other DOT regulated transportation employees, because drugs directly endanger the public and directly the nature of their ability to perform the functions of their job.
So, no, I don’t think this is a fair comparison. Drug testing politicians is not about the nature of their work, and it is extremely unclear that drugs are at all pervasive among politicians or have any meaningful effect on their performance or the public’s safety.
Drug testing people is just a dumb voter reactionary position.
How do we factor in "this guy is a raging alcoholic"? Not a serving politician per se, but evidence points towards our SecDef having fallen off the wagon if he's ever been on it.
Bad representatives should be voted out regardless of whether they’re using drugs. Good representatives should be reelected regardless of whether they’re using drugs. If you need the test to tell you whether they’re on drugs, they’re doing fine.
Officers and pilots also take fitness tests? Do we have a solid idea of a fitness test for a politician?
Yes, and they do so related to the performance of their jobs. FDR for example could not pass a physical yet he appears to have an extremely capable politician.
That was my aim. They have specific tests that we do for their jobs. Notably, the tests are not the same between them. I don't think we have an idea of how to test for capable politician.
Agreed which is why I think the OP trying to steelman the case via the example of pilots is not valuable
there also seems to be a lot of people here that believe standard drug tests are real. they’re not. most places can test for marijuana and even that is limited. what do people think is possible here?
The 6-panel drug test is what I would personally consider to be standard. It’s the drug test I’ve been required to take at least
Our public officials should be held to lower standards than cashiers at McDonald's is certainly a take one can have I suppose.
Just because McDonald's does something doesn't mean the wider society needs to adopt those standards. A society based on resentment is crap.
It's not resentment. It's the idea that we should be holding our elected officials to high standards.
We're not asking wider society to adopt those standards. We're asking it of the people who say they want to be leaders.
The only standard that really matters is “is a Democrat,” though.
Your standards are irrelevant to running a modern society.
If someone can't hold themselves together long enough to pass a drug screen they shouldn't be running *anything*.
You're trying to solve a problem that doesn't exist. Does anyone think the biggest problem with Congress right now is drug use? This is just about you looking for a way to feel self-righteous.
Is it even true that McDonald’s cashiers take drug tests? I honestly seriously doubt that.
Yeah I thought it was mostly for jobs involving heavy machinery?
I guess it might not be a corporate policy but individual franchises could choose to do so.
I don’t think it’s valuable to have politicians punch a time card or ask for overtime hours. In this respect at least, they should be held to lower standards than cashiers at McDonald’s.
The standard for McDonalds cashiers is too high.
the people yearn for government by an LLM armed with push surveys to every american's cell phone
Hahaha, unless . . .
Elected representatives should represent their constituents. “The public’s policy preferences are incoherent” does not justify taking the losing side of a bunch of 80/20 issues.
The only thing that should be an absolute disqualification from running for political office should be Republican affiliation or sympathy. Who gives a shit what drugs they take if they’re a Democrat
Whether drug tests are good policy should depend partly on whether there is a drug problem with US politicians. I don't think there is an issue at the moment.
In the UK we do have some issues with MPs doing cocaine (or buying it for sex workers).
>A policy change that saved some lives while dramatically raising insurance prices might cost lives through a higher uninsurance rate.
This is the succinct framing I’ve been looking for, thanks Matt.
Man, I am really not looking forward to the coverage of Mangione’s trial over the next year. I expect to have to listen to friends I otherwise consider good and moral people sully themselves carrying water for a murderer :(
Unfortunately, the same people that think the CEO of a healthcare insurance company kills trillions of people a year also think that "the company charges lower premiums and increases coverage, but takes less profits" is a meaningful alternative
Probably the same people who think nominal grocery prices are too high because the grocery stores are raking in huge profits.
I was shocked by the number of ordinarily thoughtful and ethical people who reacted to the murder with "murder is bad, but our insurance system is killing people." In the vast majority of cases the types of insurance company behaviors that they thought were killing people were things that are illegal, usually as a result of Obamacare so these practices have been illegal for over 10 years.
Most favored single payer and were convinced that single payer was the only way to get rid of these already illegal practices. And they seemed rather shocked when I pointed out that one of the big problems is balance billing and providers have been fighting laws that require them to accept fees of some multiple of Medicare rates when they are out of network. I don't see how an insurance company paying 2x the Medicare rate instead of 5x Medicare that the provider wants is the bad guy.
I hope he walks on a technicality, honestly.
The police seem to have done a rushed job and focused a lot on content creation rather than police work. I’d appreciate a very memorable demonstration of why work comes first and Mangione seems like the least dangerous person who would also provide that.
I share your concern with due process, but I would really, really like to see every politically motivated assassin sentenced to prison ASAP in the current climate. If Mangione genuinely was not the shooter responsible, I hope that comes to light so the real killer can be found. If he was responsible, I hope the police gathered enough evidence in accordance with the law to put him away for life. Any other outcome is a bad outcome.
Yes, police incompetence is a bad outcome. You could just agree and move along.
According to the "defense attorney," the police did a rushed job. The defense attorney fighting a very long uphill battle.
To clarify, several of his defense attorney's motions to suppress evidence were basically attempts to remake case law in his favor. The more recent "revelations" are just the pointless details true crime amateur sleuths obsess over.
I’ve held this opinion since before he had an attorney but go off.
Extremely good bit to begin a response with “To offer an optimistic framing…” and end it with “Unfortunately, this may be the end of humanity.”
That made me laugh out loud
I wonder what percentage of the 78% who think voting in ways contrary to what the majority of people want is "corruption" actually know what the majority people want.
The question wording is a little weird, there's a whiff that this vote for one's social group or "elites" has a pay for play nexus.
But, there's a long line of political rhetoric against "special interests" politics and a long line of political rhetoric against "moneyed interests." And, Matt's own "stationary bandits" rhetoric is much the same. So, I think it's worth taking at least semi-seriously and file under more research needed.
In addition to this point, when you define corruption so loosely, you're always going to be disappointed in a nihilistic way since you've created a nebulous definition that will just shift to reflect your disappointment in life. "Corruption" isn't some obscure technical term thrust on the public. Everyone should be able to figure out what it is pretty easily.
Maybe, Corruption is a spectrum.
I agree that the online pseudo-idealistic cynicism is unhelpful. But, assuming this is tapping into a more basic disdain for cozy deals or special interest favors it's worth thinking about. I feel like any anti corruption reform proposal that assumes everything was fine until Trump came along isn't going to move the needle.
Pseudo-idealistic cynicism is a great term for describing this type of outlook.
I'm not sure if any reform would necessarily have to deal with the pre-Trump world. But if you're defining corruption as "votes in a way I don't like" instead of "selfish quid pro quo deals," you've basically defined corruption so broadly that you can't really have rules in place to deal with it. You can enact reforms around Congressional stock trading, the types of jobs they can take a few years after leaving office, etc. But are you going to have rules governing how members of Congress have to vote? When you define corruption so vaguely, you have no way to measure if any reform has increased or decreased corruption.
I've had someone tell me with a straight face that a state that has a a trifecta is a "dictatorship" and was surprised when I informed him that Russia was one. I don't really know how you deal with such people.
> "Corruption" isn't some obscure technical term thrust on the public.
That’s exactly the problem. If it was a technical term, we should be able to figure it out easily. But when it’s just an intuitive term that everyone throws around in different ways in different contexts, it’s not at all easy.
But defining it well and "claiming it" more forthrightly would have many political and practical benefits right? Corruption should include:
- receiving or directing any consideration for pardons or sentence reductions;
- using non-public information obtained from governmental sources to trade or make investment decisions;
- directing agencies to pursue criminal investigations or legal proceedings based on personal or financial motivations;
- directing any public benefit toward family members or business associates...
...and on and on
There is a very long list behaviors by members of all three branches that should be outlawed, and the public understands that. The problem is that this list of strict but sensible and politically appealing prohibitions won't pass Congress until one party is willing to bite the bullet and promise to live under the constraints it creates, "Contract with America" style.
There is a balance, there is also a problem of people defining it so narrowly that is causes them to ignore corruption. The anglophone world has very little bribery but lots of retired politicians getting very generous speaking fees and non-executive directorships.
We're so far from people defining it too narrowly that this really isn't a concern.
“Taint” is probably the more accurate word for what the public perceives.
Oh, man. You need to re-read that sentence...
I think this loose theme of corruption has legs though. It might also pull in some of the anti-rich folks while being more accurate - like a lot of big corporations are actually f---ing you over, and that's "corruption" in some vibes way...
This line of thinking is hugely corrosive to society because it diverts attention away from real corruption by muddying the water and making fighting it harder.
This is a common tactic of corrupt authoritarian governments because it makes less politically active people assume corruption is everywhere and believe it's hopeless to try to do anything about it. It also creates a permission structure for more corruption since everyone is corrupt anyway.
It has a lot in common with claims that the US is has become a fascist nation because of Trump. This is a similarly corrosive attitude because if the claim were true, fighting it is a lot harder than if the US is just a nation lead by fascist wannabees that so far have had their fascist tendencies constrained by the institutions of government.
Superliking™️ this comment for articulating my thoughts better than I have been able to this morning.
The widespread default to thoughtless “reasoning” like this seems to be a throughline for a lot of stuff I’ve read in my various (too many) substacks this week. I’m a longtime SB subscriber and I think this is the most depressing mailbag, possibly the most depressing post, I’ve read here.
Not sure why you assume that actively pursuing the goal of ending corruption in politics (made vivid by Trump's actions) is "divert[ing] attention away from real corruption." It is focusing attention on real corruption.
I don't think that. I wish people took corruption by politicians like Trump much more seriously.
To me the premise of the question is that the majority’s wants are known—their district just had a terrible weather event and they expect their rep to advocate for them.
Or if you replace “social group” with one of “the groups” Matt occasionally mentions and the examples seem numerous.
I think most people consider their representative’s mandate to be for the good of their district and to a lesser extent the good of the country and if the rep doesn’t know what is good, then the majority of their district should win over the rep’s social group. “Corrupt” might not be the precise word, but I think it is the word most people use to describe a politician behaving badly.
Newsome did a long friendly interview on Ezra Klein's podcast. I'm still against nominating him, but I have to admit the guy can talk - either authentically off the cuff, or at least close enough to fake it. That's a skill the nominee will need IMHO.
He is indeed a very good communicator. And, Bay Area pedigree and Pat Reilly hair aside, I personally think he mostly gives off "normie" vibes.
For all the reasons Matt states, it seems like it would be a bad idea to nominate him, though (at least if beating MAGA is high on your priorities list and so you therefore want to maximize your odds of victory).
That said, I can't find myself too terribly afraid of the prospect of Newsom as nominee (though I probably *should* be more concerned). I can't help but think if he actually had a limousine-liberal glass jaw, it would probably have shown up by now. Newsom really couldn't flip three or four states in a pro-Democratic cycle? I also think there's a decent chance we may finally get a not-so-close election: Trump is ruining the country.
But this is all just vibes based. Probably the election will be close again. And the cycle might well favor the GOP, who knows? So, the conventional wisdom remains: avoid nominating someone whose main qualification is beating other Dems. I myself am gunning for Besehar-Gallego.
I’m worried that bashear is secretly not charismatic at all
For my vantage point, Matt seems to underrate charisma.
It can't be that much of a secret when everyone who glimses him on tv sees it.
People thought Scott Walker was going to be a bigger deal then he ended up being once people saw him on national TV.
That could be the case. I'd also be happy with any combination (pick two) of Shapiro, Gallego, Kelly, Buttigieg, Whitmer, Raimondo and one or two others.
I'd like to think if charisma is an issue for Beshear, we'll find out very early. Maybe even before Iowa.
I thought this interview his did in October was pretty good. https://www.youtube.com/watch?v=phjuIezI7R4
He argued for extending the ACA subsidies, hit Trump on tariffs, and avoided taking the bait on a gun control question towards the end. I don't know how much he will excite news junky liberals but at least he seems to be a comfortable speaker.
yeah I just started watching this interview and I'm already getting sleepy:
https://www.youtube.com/watch?v=ckvxptWu2p4
My POV is that most normal people will NOT listen to 2 hours of him talking, and I think the first impression of a slick California Democrat is negative. People who give him a chance might be converted - but most people won't!
Versus someone like 2016 Sanders - I did not agree with his politics/policies, but I could see why the first impressions were good ("this cranky guy understands that I'm getting screwed over here! finally somebody gets it!")
I suspect he has a ton of things like the California Agricultural Land Equity Task Force, which will get dragged out and raked over until hell wouldn’t have it. Sec Rollins is already putting out press releases about it - has made the farm news, not general yet. As in
“[T]he United States Department of Agriculture (the Department) writes to express substantial constitutional concerns regarding the state of California’s proposed redistribution of agricultural land based on race, ethnicity, and national origin. The proposed policies would grievously harm farmers, ranchers, and agricultural producers,” the Secretary wrote in the letter.”
For me the thing that stands out is his past advocacy for repealing the Second Amendment.
A stance I personally favor that is completely crazy for any high-level politician to take!
I personally think a reasonable reading of the Second Amendment allows bog standard, rich country gun safety regulations—no repeal is needed—just good faith judges.
But regardless of where one stands on that point, yeah, it's nuts for a politician with national ambitions to espouse such a policy goal. It's both utterly unrealistic *and* political malpractice of the highest order.
Republicans will have to nominate someone truly terrible before I will vote for Newsom. He signed Senate Bill 132 to allow males with penises to be housed in women's prison cells. There was an existing rule allowing males with bottom surgery to housed in women's prisons, but that wasn't good enough for the ACLU, they wanted men with intact penises to be able to access female prisoners. Not surprisingly there have been many many cases of women being beaten and raped in prison since 2020. Newsom is very beholden to the groups.
The problem for me is that I suspect Newsom is bad on the merits. He’s never really supported any good policies as far as I can tell, and he’s often campaigned on actively bad ones. He might or might not be electable, but he’s not someone I trust.
I feel like we’re going to have to get back to good policies waaaay down the line. In 2029 we might need to be, like, rebuilding the entire department of education and figuring out who needs to go to jail for out of control crypto corruption.
Biden’s big promise, which he kept, was “hey guys that was a crazy four years so let’s get back to just governing, huh?” And it just doesn’t stick. We might instead need someone who can take really big, maybe really partisan swings. I would love it if they also had correct opinions about permitting reform but I don’t know if I can get my hopes that high.
I honestly haven't studied his gubernatorial administration in any detail. California seems to be doing about as well as anyone these days in pushing against NIMBYism—that's one mark in his favor in my book.
This seems uncharitable; California recent pro-housing push has been genuinely positive and Newsom has enthusiastically backed much of it.
It’s not for a lack of trying but I just can’t get myself to dislike Newsom or be that worried about him winning the nomination. And that’s in contrast to “getting” the nomination - as someone else pointed out, no one is out here saying it’s Newsom’s “turn” like it was for Harris, and sort of Biden, and Clinton. There’ll be a real field, and if he wins through it then he’ll probably have done something right.
But on the interview it’s really striking to me the extent to which he’s willing to take (rhetorical) accountability. In plain non-squirming language he’ll out-and-out say “I was communicating the wrong way about the economy” or “we were wrong about the approach to the border”, both issues being good ones to reverse on but also both framings of “I” and “we” seem really important to be able to deploy. And also, I would think Matt would appreciate this exact approach more. He’s always saying the way forward isn’t normie vibes, it’s being able to publicly, convincingly moderate on specific unpopular issue positions. Is anyone doing that as well as Newsom?
Gallego maybe, but you have a great point.
The positive case for him over the Dems last three nominees is that he isn't heir nominee and if he gets the nomination he will have to build his own coalition. He seems like a decent communicator and a more willing to basically do what it takes to win.
That said, West Coast Dems really are a different breed and there's a lot in his record that will be vulnerable to attack. And while he seems like he has some political skill it's all trained in that particular political environment. All Matt's list is more interesting to me than Gavin.
Californian here. The positive case is that Gavin Newsom is incredibly like Bill Clinton, except for the one big disadvantage of not being the governor or a red state. But he is utterly without scruples and endlessly adaptable, so he will assemble any coalition and do/say anything it takes to win.
And he looks much more presidential than most candidates. If I was casting someone to play a Senator or President in a movie or TV show, I would pick Newsom. That is probably worth 5 points in America. That hair!
He sounds confident too. I still remember when he and Trump had daily briefings on Covid. Night and day difference.
That’s fine. The important thing is that we have a Democrat that can win. The second most important thing is that we have a Democrat who once they’ve won will do the worst things that Trump imagines doing in his fever dreams to Democrats, but to MAGA, so we don’t have to deal with this crap again. The next Democrat needs to seize enough power to completely, permanently destroy MAGA. I don’t really care what else they do while in office.
The fact that Newsom actually brings some testosterone to the fight is a huge plus. I don’t think he’s that scrupulous, and that’s also a plus - he might actually do the necessary second thing. But the California factor will probably prevent him from winning, and that’s a necessary precondition for anything else.
Another life long Californian here (until 3 months ago). He is Clinton like, but without Clinton’s smarts.
I always say CA did well Despite dysfunctional Dem politicians, not because of it. While I do believe GN will do less damage than Trump, can we have someone better?
That sounds about right. We'll see how he compares in raw political talent to prime Bill.
One time I was in a restaurant in my very purple town and I overheard the next table talking loudly about how they were huge fans of Newsom (a thing I have never heard from my reliably liberal friends), which was a bit shocking to me given what Slow Boring had always said about his lack of appeal to swing voters. It made me wonder if I can really rely on Slow Boring to know what residents of purple places are like. Of course this story is statistically useless but I do think we should remember that mocking internet leftists for not understanding swing voters doesn't give you yourself a royal road to understanding them either.
Maybe, but it's worth noting that even in a purple town 40% of people are pretty reliable Democrats, so the odds are high the people you heard are not swing voters.
The swing voters in my family from Nevada really like Newsom too. I'm sort of surprised that SB is so bearish on him - prior to this week, my impression was that far lefties hated Newsom for backing away from medical care for undocumented people and trans women in sports but that relatively disengaged voters like him because he's slick and snarky and comes across as a moderate.
I think your impression is correct. Slow Boring doesn't have any disengaged voters, though.
I think Newsom is being underrated in the same ways Biden was in 2020. He's likely to be the frontrunner, although I don't think any individual person is over 50% odds.
Disengaged voter here.
Oh, of course, I have no idea who those people were. What surprised me was that based on the way people on the internet talk, genuine enthusiasm about Newsom was not something I expected to hear from _anyone_, swing or otherwise.
I just finished commenting on how after his recent interview with Ezra Klein, I walked away thinking I could really see the swing voters in my life going for him. He's got that funny, bulldog personality that so many fell in love with Trump for, but he channels it much more productively.
He did good but I think he would have such a stronger story if he had another term of “fixing California” and wresting governance from the hands of crazy leftists. That would be an awesome story to run for president on, “I saved California from the libs!”
The problem is that California has been so poorly governed that the attack surface is massive. Republicans could credibly run adds about California having arguably the highest poverty rate in the US and most expensive housing and it will be true
I think you're crazy! That was a TERRIBLE interview!!!!
He just rambled! Then he told us all that he got a below average score (960!!) on the SAT and said, "I can't read. I takes many reps for me."
Is he reading, you know, REPORTS?? LEGISLATION??!
AAAAAAAGH!!!!!!!!!!
Theory: mentioning the low SAT score is part of courting the "anti-elite" vote.
Because the vibes voters aren't interested in the smartest guy in the room any more. If they ever were - remember Dubya?
He's dyslexic. It's not news.
Are you talking about the Ezra interview? He mentioned his 960 SAT score in the Tim Miller/Bulwark interview. Did he also do it in the Ezra one?
YEP.
Fascinating. I thought that was a sort of throw away comment while the two of them were just bantering.
I guess with well-rehearsed politicians, little of what they say is ever off-hand or throw away. Everything is probably focus group tested. Not sure what this says about the value of focus groups.
Given that 960 was a pretty atrocious score even when Newsom would have taken the SAT, I'm guessing that he's been advised to bring it up a lot now to defang it as an attack line later.
Yeah, that's an"I was hungover as shit and ended up at Sac State" score.
I was going to say… not to be a crank, but SAT scores correlate moderately positively with IQ, and I’d be genuinely worried if Newsom were sober taking that test.
He also did a good one with Tim Miller on the Bulwark yesterday and while I don't really know enough about Newsom to disagree w/Matt's assessment, I didn't hear anything in this interview that seemed like a huge red flag. There's an especially interesting part of the convo about Charlie Kirk and Turning Point USA:
https://youtu.be/frLiRbeuTpg?t=2457
I think the red flags are all his previous unpopular positions. Or his hypocrisy during COVID (French Laundry incident)
Anecdotal, but when I talk to normies, the French laundry hypocrisy is what they always bring up. Would be hard to shake that. Hell, even I find that hard to get over.
It really is unfortunate that the ACA has become a kind of orphan. I'm one of the people who thinks it didn't go far enough but M4A isn't the only way to achieve a good system, to say nothing of those who hate it for no reason other than its association with that devil Barack Hussein Obama. The problem isn't necessarily the payer (i.e. public or 'private') it's the patchwork nature of the system. There's enough there in the bones of the ACA to consolidate the insurance market into a more effective universal coverage system that people can navigate in a reasonable way, plus reforms to push for more retail-ization of healthcare. Yea it'd all end up looking like a big box store rather than a social democratic paradise (or... I dunno a place where people are denied care for fun and profit or whatever the GOP vision is) but that's just how more or less effective things end up being in America.
A lot of the problem is lack of cost transparency ahead of time. Making prices readily available would help.
OMG is this true. I have a high deductible ACA plan and I needed an MRI that wasn't an emergency. I tried figure out how to get the lowest cost MRI from respected in-network providers, based on insurance negotiated rates.
The process was frustrating and took around 3-4 hours. I needed to practically become a medical billing expert and learned all about medical coding. The highest price was over $3k and the lowest price was $400. I was convinced the $400 price was a mistake, but went for it anyway and it did work out.
I have no idea why prices are so varied for a standard in-network procedure that's somewhat common.
I think there would be lots of value in local journalists calling up local companies asking for MRI quotes and then putting the names of the ones who refuse to answer easily on the front page.
There's only about twelve of those left; how will they find the time?
Someone could start a website and crowd-source it. A Substack for medical price lists. MRI_prices dot substack dot com, sinuplasty_prices dot substack dot com, etc. Substack is maybe not the ideal format for searching, but once it's posted online you can google it and include "substack" in the query.
Social media would be better --eg reddit. People could post prices and geographic location on reddit, mods could compile a list of verified users, and they could manually or automatically compile prices by year and MSA (or by state for non-MSA counties) to make a sort of volunteer-run census of medical prices. Reddit is good at getting volunteer labor, the problem is spam, hence the list of approved users.
I remember reading an article a couple of years ago (NYT, I think) in which a doctor who worked in the hospital couldn't get a straight answer on what the cost of his MRI would be.
Price transparency is huge. Also removing the dependency on employment. Get those 2 things resolved and it would act like a much more efficient market.
The first is much easier to tackle and IMHO is the bigger problem.
Competition requires price transparency. Solve that, and then just focus on increasing healthcare supply faster than demand
Healthcare demand is a gaping maw that will never be satisfied lol.
The ACA did remove the dependency on employment, at least in the sense that if your employer doesn’t offer coverage you can get it on the exchange. I was able to go straight from law school into solo practice because of the ACA
There's still a preferential tax treatment of employment based healthcare premiums right?
I'm not a tax expert, but I think self-employed people generally get to deduct their ACA premiums as long as they have enough net business income. The catch is unless you set up some sort of corporate tax entity (like an S-Corp), you still have to pay the full self-employment tax (2x FICA) on that income even though you get to deduct it and avoid normal income taxes.
I believe normal large company employees don't have to pay income tax or FICA on health insurance benefits, the premiums are all paid by their employer fully pre-tax.
You seem like a tax expert to me :)
Compared to cash income, yes. But you don’t need to have a job to get health insurance anymore.
You didn’t need a job to get health insurance pre-Obamacare either. It was called the individual market.
Dependency on employment is trickier, since most (est 63%) employer insurance is self insured, with the insurance company acting as a claims administrator / stop loss provider rather than acting as the insurer.
Yeah, this is interesting, though it’s definitely the weeds. I have state employee health insurance that’s administered by a Blue Cross group. I just looked it up and saw that the state is self-insured. I should yell at my state Congresscritter to pay my damn ozempic
Tell me about it. My doctor wanted me to get a bunch of tests done. Not only couldn't I find out how much my insurance would cover, I couldn't even find out what the out of pocket costs would be if I paid myself because of complicated pricing models. I am lucky that I have disposable income, so I could pay the resulting $580 bill, but the tests didn't reveal anything new about my health situation. If I was a person living closer to the margin, I would have been really mad at myself for making the decision to get the tests. I am still annoyed at myself for not asking more questions.
Very much agreed here.
I think we need to mandate all prices be posted online, and also ban price discrimination by providers. IE the provider shouldn't be able to charge different prices to different payers for the same service.
For competition to work we MUST have price transparency.
Should they be able to offer discounts to people with insurance?
No.
Of course.Your insurance will still pay for a large part of it, but the price will be the same
In theory, Medicare already has price transparency rules for hospitals: https://www.cms.gov/priorities/key-initiatives/hospital-price-transparency/hospitals
A price transparency act was introduced in the House in 2023 (by a Republican from Ohio) but didn't get far: https://www.congress.gov/bill/118th-congress/house-bill/410
Congress ordering healthcare providers to make their prices readily available would go a long way to fixing the exorbitant and unpredictable prices and confusing billing that plague US healthcare consumers.
Yes. If we could get that for all payers, that would help.
Would also help to make prices standard, regardless of payer. Right now, uninsured pays higher rates because of payer-specific discounts.
Mental decline tests strike me as quite dangerous when considering who gets to design the test, and how it could be used for ratfucking purposes. Drug tests seem like a solution in search of a problem. Agreed with Matt on tracking time being terrible. Town hall meetings would have to be calibrated very carefully to prevent grandstanders coming to just yell at politicians they don't like.
I hate to fall into the "no, it's the voters that are wrong" pit, but...
Not sure I agree understand your first objection. Cognitive assessment tests already exist and are used by doctors in a completely non-partisan manner, just take an existing test and require all elected officials above [insert age] to take it every 6 months or whatever. Where is the “ratfucking” potential? It’s not like “white people get to read a simple sentence, but black people must read and interpret a complex paragraph in order to vote.”
/scientist hat on
Make it a written test, and have it scored by two doctors (working separately) who don’t know who the test taker is. Like, give each doctor a stack of five cognitive tests, where one of these is from POTUS, one from an 80-year-old Senator, two from 80-year-old private citizens, and one from a 25-year-old congressional staffer just for fun.
The issue is that all of your guardrails require very honest people doing very honest work. Except that this test presents a very juicy opportunity for anyone that can game it in thier favor. Not just money but control over the most powerful government in the world.
I think releasing the results publicly might be good - but forcibly removing from office is weird.
There’s zero chance that the political class would let two doctors determine who wields power. Either they’d nerf it or use it for ratfuckery. No other possibilities.
It's certainly possible to create a neutral test as you describe--I worry that politicians are going to politician and try to rig such a test in their favor.
You’d have to be super rigorous about the doctors not having any way of knowing which test results are whose.
Why do you think there is even the slightest chance this would be how it worked though?
The fact that we have an election system that basically works.
When I was a professor at Texas A&M, there were constant murmurs that legislators were going to start requiring us to track the number of hours we were in our office on campus. The university administration told us that the legislators were constantly suspicious that none of us were taking medical leave in order to go to doctors appointments. I guess that’s a thing that office workers with strict 9-5 schedules have to do?
Even those without strict schedules in many cases. My job requires this, and I'm not paid hourly. If it's 30 minutes at the end of the day they're lax about it but if I'm going to miss 3 hours to go to/from the dentist then I need to use sick leave.
Neither my husband nor I have had to use " medical leave" to go to an appointment. We just agree to make up the time elsewhere, work through lunch one day, etc.
When I was a time card employee briefly yeah sure, but not normally
(and then it wouldn't be medical leave, just unpaid)
Um, I have never heard the term "ratfucking" before, but I'm about to tell all my musician friends about it because we need something that vulgar to describe some of the behaviors in the industry. Currently, we call that "shenanigans", and I want to throw something every time I hear someone say that.
It's really great vulgar slang for using dirty tricks to defeat one's political enemies. I'm sure that there's plenty of ratfucking that similarly compares in the private sector.
Update: I posted a PSA about the availability of the term "ratfucking" on Facebook and the nice older ladies from the park that had me over for Thanksgiving were so offended that they didn't even accept my apology after I brought them a cinnamon bun!! ☹️☹️☹️
I think I need to make a filter so not everyone can see posts where I swear.
I feel so shamed!! Like, c'mon, we're all ladies here! It's not like I'm some 10 ft tall jacked leather man in a bar that's swearing and making people nervous that I'm going to accidentally elbow them in the face!
Sad! Make sure those ladies don't come across any Muccigrosso comments.
Who's that?
He's a Slow Borer who is renowned for being the most profane commenter on this site.
You should check out the Balloon Juice Lexicon. It’s old, but it’s like urban dictionary for political blog junkies.
https://balloon-juice.com/balloon-juice-lexicon-a-z/
It's a good instinct, but hard to imagine a successful implementation. Unfortunately, many things are like this.
It's part of why I'd much rather go with a maximum age of 70 for running for office. We have minimum ages, so I think we should have maximums as well. It's very easy to verify age compared to mental acuity.
That Searchlight finding is a depressing warning siren:
"[O]ver three-quarters of voters (78 percent) consider a politician corrupt when they vote the way that elites in their social group want, instead of what most people want."
That number is crazy!
Taken as a 𝗱𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝘃𝗲 claim, it shows how Americans continue to live in harmful ideological bubbles. When "everyone you know" agrees with a policy, the only possible reason someone might vote otherwise is that they're on the take.
The 𝗻𝗼𝗿𝗺𝗮𝘁𝗶𝘃𝗲 claim it implies is equally bad! People have accept that public officials will have to enact unpopular policies from time to time. To act or believe otherwise is childish and petulant
Liked for use of bold typeface.
What does "voting the way that elites in their social group want" even mean, and how do people think they can observe this?
I interpret that to mean that, given Bob and local elite Alice, when politician Carol votes in ways Bob disagrees with, Bob infers that Carol is promoting Alice's interests over Bob's, either in an explicitly corrupt way or a more nebulous sense (i.e., just another instance of "the rich get richer").
I saw that attitude first-hand a month ago during the elections, when it was all over Facebook and Nextdoor. A contingent of unhappy voters were furious with our deeply progressive mayor and city council for spending reserves on capital projects rather than increasing the school budget. They conjured wild conspiracies to explain the politicians' unwillingness to implement the insurgents' preferred policies (and almost succeeded), and when they didn't suggest run-of-the-mill corruption, they implied it in more general terms like "this town is run for the rich."
So in other words, entirely impossible to address in a broad enough way to actually get votes.
Regrettably, I agree.
Related: paying close attention to local politics taught me that you 𝘢𝘳𝘦 going to make enemies, so successful politicians absolutely have to make friends too. Preserving the status quo, no matter how good it is, isn't good enough.
There are 2 definitions of corruption: corruption of the soul (that is, being part of MAGA) that’s getting confused with textbook corruption like embezzlement or graft.
The public broadly isn't Burkean - because we operate in a representative democracy with comparatively few intervention points and little leverage once they're in office, it's not crazy for the public to want elected officials to faithfully represent their collective views as much as possible. Progressives want power and a quiescent electorate who'll let them transform society in a favored direction, something national voters have rejected.
I really don't get the Newsom love from some people, and they get pretty irked when I say he's a worse version of Kamala Harris. Some hardcore Democrats really struggle with the idea that delivering sick burns to the opposition (see Jasmine Crockett, too) isn't what makes politicians electable in difficult races. Those people are nice to have around, but they should be running for most offices.
Newsom can do interviews without embarrassing himself, which Kamala couldn't- that's an important skill for a politician.
I think giving 2028 takes before the midterms is fundamentally a foolhardy endeavor. Nonetheless, he is clearly a better communicator and more willing to change his tack when things don't work out than Harris, who seemed like a deer in the headlights anytime she got tripped up on something.
I won't compare him to possible 2028 contenders. It's too early, but he seems better than Harris. The sliminess allegations just don't hit that hard at this point in time.
>The sliminess allegations just don't hit that hard at this point in time.<
And quite honestly, they really haven't hit very hard since 1992.
Even the slightly more erudite version of this demonstrates a failure to put themselves into the mind of an opposition voter. I often see something along the lines of "Buttigieg would be a great candidate, look how he goes on Fox and adeptly ridicules the arguments the hosts offer him." And, like, OK, when a Ted Cruz or some other conservative with fairly high verbal acuitity talks circles around a liberal, do you find yourself more kindly disposed to them?
Are there people on the American left who would even admit that it's possible for there to be such a thing as a "conservative with fairly high verbal acuity [who] talks circles around a liberal"? (I'm 100% serious in asking.)
Are there examples of this happening that isn't just dunking on college kids?
Buttigieg is specifically good because he goes toe to toe with the conservative pundits.
I would wager there are some good conservatives that can hold themselves well. Tim Miller would have been a good choice, but a lot of them are getting rebranded liberal without being a democrat. Nothing wrong with that, but it makes the search for conservatives examples difficult.
Miller was never really super conservative though... these days he might be a left Blue Dog.
I have no clue if there are any examples of that which aren't just dunking on college kids because it's not a thing I go looking for. (I'm not familiar with Tim Miller, sorry.)
Without having an example, it makes the question of whether anyone on the left can admit it is possible kind of frustrating. :(
I admit it is possible. Would be great if they existed. Even better if they were celebrated and rewarded in conservative circles.
Well, you can ask Kirk Setser if he has an example. He was the one who started with that hypothetical.
I hate JD Vance, but I'm pretty sure you accurately described his debate with Tim Walz.
Ross Douthat is also a very good talker.
Whatever anyone thinks of newsome he is not Kamala Harris. He’s very very good on his feet and as governor has made some shrewd and difficult policy decisions with tradeoffs. Frankly, he also has much much more experience in governance than her.
Maybe, but CA is still VERY poorly run. And while he's nibbled around the edges of those problems he hasn't fixed anything.
My local schools are great, my neighborhood is very safe. I don't know where people get "very poorly run" from. Feels lazy.
Let’s see: the two signature cities of LA and SF all have intractable problems (many started when he was a mayor). The high speed train fiasco, PG&E….
He might be better than Harris, but I know so many people who just “hate” him much more than Harris. He needs to be able to get past that.
His best chance is to fix CA in some way before ‘28. Then he has a chance.
I don't disagree with anything you said, but I'm curious who these haters are. If they're leftists, or even center-lefties, then that's a good thing.
Frankly I have very Trumpy family that think badly of California but like Newsom as a slick talking guy with a veneer of "success" to him. He could win their vote. Harris could not.
I think Newsom is a pretty good foil for Trump. But around 2027 I’m starting to think Trump will be a paper tiger given his obvious decline. We’ll have to see who the anointed successor is.
Maybe you are lucky to live in an area where there are really good schools. But..
Statewide 44% of CA 4th graders are below basic in reading. Only 30% are proficient or above. That seems like a great big fail to me.
In fact Mississippi is now crushing CA.
https://nces.ed.gov/nationsreportcard/subject/publications/stt2024/pdf/2024220CA4.pdf
Math isn't much better
https://nces.ed.gov/nationsreportcard/subject/publications/stt2024/pdf/2024219CA4.pdf
Mississippi Miracle aside, and without claiming that CA is well-run (I think there’s good and bad), doesn’t that sound like every American state’s educational statistics? As a country we don’t do great when it comes to educational achievement. You could quote me that same statistic about any state and I’d be like “that’s plausible.”
Of course it's not just mississippi.
It sounds like louisiana and tennessee are doing even better. And the results lasting longer because they're focusing on a content rich curriculum.
I believe florida is near the top as well.
Some states really do seem to be determined to fix what's broken in our education system.Other states seem to be too beholden to special interests.Including large publishers and of course, teacher unions
The national average for Grade 4 NAEP math is 237. CA average is 233, while Miracle Mississippi is 239. Do we have something to learn from MS? Absolutely! But a 6 point differential is hardly "crushing."
I think we should be a lot more focused on Massachusetts (246) and New Mexico (224)
Now try adjusting those scores for Demographics
Maybe. The question is whether Gavin Newsome is the cause of that and whether he can fix the alleged poorly run issues. It seems to me that California has poor local governance and messy statehouse. On the latter, he may have some influence, but to what degree is not clear. And he has pushed back against he legislature and sought to override local governance issues (like housing). So I think the question is whether Gav is responsible for fixing these issues, and I am not quite so sure the Governor can.
That seems inconceivable to me but I can't think of a worse politician in my lifetime than Kamala Harris. Newsom saying just this single soundbite alone puts him a mile ahead of her: https://www.reddit.com/r/ezraklein/comments/1pk1984/gavin_newsom_we_failed_on_the_border
Contrasted, I don't get the Newsom hate.
I agree that the shit posting is not, necessarily, a plus. But the main criticism I ever hear is "Democrat" or "California." Some will get spicy and go with "California Democrat."
Is his track record really that abysmal? Why is California not already a difficult position to hold? That is, by the logic most are pushing forward, California must be an easy place to both win an election and do a job well enough to survive reelection...
Newsom is a successful Democrat in a very blue state. I don't hate him as a politician, I think he's done a useful turn recently to the center. I think the "hate" (of which I am a participant) is regarding his prospects in a national election against Republicans, neither of which he's done before. I would put his chances much worse than the current Polymarket rate.
Also I don't think people (either justifiably or not) would consider California to be a "well-run" state. The taxes are high, people are leaving (since the 90s, not really Newsom's fault, but they are) so it's hard to point to CA as a success story for the Democrats. As Klein pointed out, we've sunk billions into a rail project that might get you from Merced to Fresno.
I'm largely comfortable saying he has weaknesses. I'm similarly ok thinking there are probably safer choices. What blows my mind is nobody ever really gives specific reasons. They barely give vague reasons that don't boil down to, "the nation distrusts California."
Is there a longer form take that shows why California isn't at least a decently run state? I agree with some of the wild education nonsense being nonsense there. Is this Newsom's doing? Is it not somewhat correcting, now?
I think CA residents, myself included, are roughly satisfied with Newsom's administration. That doesn't mean people who don't follow CA politics (which includes most Californians) won't ascribe many facts about California to Newsom himself:
- High taxes
- Companies (like Tesla) leaving the state
- Very high housing prices, and cost of living in general
- Free healthcare for illegal immigrants
All of these are undisputed, and all of these would be very effective weapons against a Newsom presidential campaign. Harris had none of these anchors. Also I'm sure with little work one could find the type of far-left statements that hurt Harris in Newsom's past as well.
"I think CA residents, myself included, are roughly satisfied with Newsom's administration."
Newsom's approval rating has gone up recently but he wasn't a very popular governor not so long ago compared to other popular Democratic governors in swing or red states.
https://www.politico.com/news/2025/12/09/newsoms-favorability-rating-surges-in-california-00681683
I think the spends billions in taxpayer money on “free healthcare for illegal immigrants” is pretty much enough to sink any candidate outside of California. Imagine that ad campaign repeated every twenty minutes for four months.
Right, this still largely comes down to "CA bad," though?
And to be clear, I agree these would be effective weapons. My pushback is that I don't understand why we let a lot of them stand as acceptable with absolutely no pushback. This should get the same pushback that people accusing MS of being a bunch of ignorant hicks should get.
To a point I agree, but why not field a candidate without these liabilities? If Newsom already won the nomination, then sure, you don't just let all those critiques stand unchallenged.
But In the era of 15-second takes, I'm not sure a "but actually Newsom isn't responsible for all those bad things in California because xyz" message is really going to land.
As a California Democrat I just dislike Newsom on the merits. He hasn’t really been on the side of any good policies for the state, even if he has occasionally gotten out of the way of some things. Compare him to Jerry Brown or Barbara Boxer, or even the slimy Antonio Villarraigosa!
I live in Washington State and every day I am thankful that Washington State isn't as badly run as California. Some of this has to do with the fact that California is so much bigger, but a lot of it is that politicians run it badly.
What, specifically, do we do better here than CA does? What have politicians, in particular, done worse in CA than in WA?
Washington State has far fewer corruption scandals. Housing is more affordable and it gets built at a higher rate than California.
I balk a bit at us having fewer corruption scandals. Open to the idea that the police chief nonsense just stuck with me, though. Searching online, it seems that both states are middling in this grade. Curious if you know of any data to dive on that one.
Similar for housing, I would not have thought of the Seattle area as having affordable housing right now? Happy to hear if I am wrong, there. And if not talking about the Seattle area, I naively assumed there were cheaper parts of CA, too? I will also point out that CA built literally double the number of homes in 2024 than WA did.
I think the per-capita rates for home building are more important than the absolute numbers. We may have built twice as many homes as WA last year, but we have more than 4x the population, so the rate is functionally half as many, I think.
To really understand why I consider California badly governed, I'd take 3 anecdotes:
1. I went to public high school. When I took my first chemistry class in college, I realized why my mom always said that my science labs were lacking. The first lab had a bunch of metal salt reagents, and many of my peers said that they'd done the lab in high school. Meanwhile, my Chem teacher had pretty much only had us do labs that could be done with grocery store chemicals because there was no school budget for materials. The moral of this story is that because the state has never repealed Prop 13, poor districts have bad schools while rich districts who can raise parcel taxes on themselves are good.
2. The boomers I know who grew up in California were easily able to work and buy houses here. All the millennials I grew up with who still live in the Bay Area basically had to get their houses from older family members. Everyone whose family didn't have a house which they could get a family discount on has moved out of state for lower housing costs.
3. PG&E has been too lightly regulated. Their failure of maintenance has caused so many fires over the years.
CA as a state is great because of it's natural beauty and weather but it's an absolute shithole state in terms of governance.
What makes it a shithole state? Even better if you can be specifically in terms of governance? But I'd be fine with just what makes it a shithole state?
It's a very high tax state that can't get anything done. Public education is poor. Major cities have glaring problems from homelessness to public safety. Couldn't build HSR in close to 20 years. Public transport and infrastructure are poor. Home prices are ridiculously high for the average person and home contruction lags other well governed states. Even permitting for green energy is such a shitshow that it lags Texas in solar. I can't name a single thing that's handled by the state or local governments that's better than states with low taxes.
Is it actually a high tax state? My understanding is the top end rates are high. Normal tax burden is on par with every other state. Similarly, hard to complain about them not getting things done when they are the most active economy in the nation.
But your examples are exactly what I am wanting to stop taking as a given. They do not meaningfully lag TX in solar. They were just so far ahead of everyone else that their growth has slowed. (Well, that and quibbling over large projects versus many installations. CA has more total capacity still, but TX has more "utility scale" generation.)
Similarly, the transport and infrastructure are poor compared to what we can dream of. They are almost certainly still better than any comparison you can make in the states. Specifically for the amount of work that is getting done.
"Similarly, hard to complain about them not getting things done when they are the most active economy in the nation."
Private sector is not the same as public sector. Tech and the film industry benefits from access to a global market and talent. Actual growth in tech employment in CA is flat to negative the past 3 years. None of these have anything to do with the state government of CA BTW.
"Is it actually a high tax state?"
Yes, it is. You become a high tax state when you have every kind of tax that's possible and those rates are high. People nit pick about property taxes but when you have ridiculously high property taxes, your property tax burden is automatically high.
https://taxfoundation.org/research/all/state/2025-state-tax-competitiveness-index/
48 out of 50 or 3rd highest tax burden.
"CA has more total capacity still, but TX has more "utility scale" generation.)"
Me having solar on my roof is not an achievement of the CA state government.
"Similarly, the transport and infrastructure are poor compared to what we can dream of. They are almost certainly still better than any comparison you can make in the states. Specifically for the amount of work that is getting done."
I have no idea what you're talking about. FL has HSR, CA doesn't.
Neither BART, nor the LA metro are better than NY Subway or Boston. East coast in general is better at it.
Right or wrong, CA is perceived as being poorly governed by both the right (DEI, taxes, cost of living) and the left (inability to build, homelessness, also cost of living), so I think that's the biggest hurdle his campaign would need to clear.
My point is that this seems, at face value, wrong. I am not arguing that these aren't the points people will bring up. I'm arguing I wish people would just stop accepting them as given.
Note that I'm comfortable saying this should not be fought along side the presidential race. There probably are safer choices. I can still have a moot debate about the problems with this view.
To be even more direct, I'm worried that the focus on "electability" is going to land us in the same seat Republicans have found themselves in. People that can win elections but have no concept of how to actually govern. It is frustrating.
"People that can win elections but have no concept of how to actually govern. It is frustrating."
Democrats have a few good governors from swing or red states, so this isn't a valid concern.
It's not very confusing. They're right. It's a poorly governed state for the amount it collects in taxes.
As a California Democrat who's voted for Newsom plenty of times, I've never liked the guy. He's always seemed like he's only in the current job as a stepping stone to the next job and like he doesn't have any real core values.
I also just don't think we should be putting California Democrats in national leadership positions in general. We're just way too far away from the median American voter in the way we talk and think.
This is very vibes feeling. Has he done a poor job? Has he shown bad values?
It's hard to describe this quality exactly, but I think his response to dealing with our high-speed rail boondoggle is informative. He's the one who downscaled phase 1 down to be Merced to Bakersfield from the original ambition of SF to LA. He was correct in thinking that the current project has cost too much and taken too long. However, to me, opening a line between Merced and Bakersfield is basically trying to get anything done whether it makes sense or not. Someone with real vision would look at the same set of facts as Newsom, figure out what would need to be done to rescue the LA to SF vision, and get to work trying to do it. No one wants or asked for a line between Merced and Bakersfield, and it's lame to leave it there.
Additionally, housing scarcity and homelessness has been a problem in every position Newsom has held in his career, but he only got on the YIMBY team after Abundance came out. He never bothered to do anything about it before because he didn't want to be unpopular with NIMBYs.
I guess my overall problem with Newsom is very similar to my problems with Biden: if a president doesn't have his own clear objectives for the job, then how will they prioritize? I want to know what they want to do with the job, and Newsom is a cipher on that front.
I find both newsom and harris more authentic than someone like slotkin, walz, shapiro or pritzker. Polis maybe the one exception i can think of.
To defend Sam's wife's intuition (a good spot for me to pick, I guess), strictly providing poor people with more money isn't always the right play. We also want a broadly inclusive society rather than one that's completely stratified by ability to pay.
To pick a different example, the lifetime earnings advantage of going to a fancy private university is plausibly less than what the university pays in financial aid for poor kids. So in some sense "everyone would be better off" if Harvard gave the kids the money, the kids went to Wisconsin or Georgia or Arizona, and Harvard was 100% rich kids. But obviously that would be terrible for our society and no one would do that. The argument that having the Vatican Museum or Taylor Swift shows or NBA games be 100% for this would be bad is similar if less extreme.
A couple of other points. 1) Some people, including myself, enjoy things at least partially based on a feeling the price paid was equal to or less than the value received. That is, doubling the price of visiting the Vatican might decrease net enjoyment, even if the experience delivered was objectively superior. 2) Higher prices do not necessarily convey to the consumer that the good or service being pursued is in high demand in the way that crowds and waiting in line does. The Vatican may place some value on impressing that sensation on visitors.
Harvard manages this by having a limited number of slots that get given to legacies and donors and the rest are more open. I think concerts could do this by having a number of tickets given out by lotteries to superfans and a limited number sold at auction to the highest bidder. There are many ways to structure this to get the best of both.
"if Harvard gave the kids the money, the kids went to Wisconsin or Georgia or Arizona, and Harvard was 100% rich kids. But obviously that would be terrible for our society"
Why would that be terrible?
Because it's important that the important institutions of our society, of which Harvard very much is one, are open to people from every walk of life. Additionally, elite institutions replicate themselves -- it is more challenging to join the elite without access to elite institutions. And a hereditary aristocracy would be bad for America. (I can argue for that claim too if necessary.)
If they really cared about that, they would rely more heavily on standardized tests or have their own entrance exams instead of trying to screw Asians over by giving them poor scores on a “personality” test and expecting them to score 200-300 more on SATs than other minorities.
If they really cared about what? Their behavior is very consistent with their goals of having Harvard remain very important and maximizing the share of very important people who went to Harvard.
Cared about allowing people from all walks of life instead of cooking their diversity stats by admitting black kids from well off families from Africa or the Caribbean to make up their racial quotas over more meritorious students from poor families.
You should perhaps consider that (a) my goals and Harvard's goals are not the same and (b) admitting rich people from Africa who will go on to become important fits precisely with their goals!
Actually I think in your scenario Harvard just becomes much less important of an elite institution, which would be good (same for the rest of the Ivies).
Of course that's already starting to happen anyway
Why is it obviously terrible for society that Harvard has a smaller endowment relative to the counterfactual where they charge tuition for students whose families make less than $200k annually?
I'm confused by the connection between the size of the Harvard endowment and what I said. Can you say more?
I must've misunderstood what you were suggesting. Harvard currently gives poor and lower middle-income students money to attend; if they jacked up prices and gave kids money to attend cheaper alternatives, their endowment would be larger (they're charging more than other schools cost so still making more money, and state schools are already pretty cheap). But before all of that, the obvious thing they would do first if they thought more money would help would just be to charge money from students who are already attending!
What I'm saying is that if Harvard gave low income kids 400k each to not attend, and they went to a state school, the literature on the marginal value of getting into a fancy school suggests that the poor kids would be richer overall.
But even if that's true the overall consequences of making important institutions in our society accessible only to the rich would be very negative.
I have never posted, but the Brian Thompson question and answer really missed the mark. The answer to Brian Thompson being responsible for some deaths is 100% yes. Just like Trump is responsible for some deaths. And Obama. Anyone who has to make allocation decisions around scarce resources is ultimately making it more or less likely that somone will live or die. This is not really why people cheered his murder. The reason people cheered his murder is that the public does not agree that the reason for making the allocation decision is valid. Everyone understands that the local government only has so much money and can only extend so much support for poor family heating susidies in winter. And we recognize without admitting it that the cutoff line means increased risk of death. But collecrively we accept that as just. We do not accept that it is ok to risk a person's life to increase corporate revenue or profits. That is conaidered unjust. Every time UHC took a person off some working treatment for Crone's disease to make them ramp back through cheaper treatements, they risked a life. Every time they delayed a cancer trial to cycle through failed treatments for the sake of revenue, they risked a life. And the resentment of forcing people to take that risk, and the resentment of their friends and families, and the fear that resentment inspired in others, is what people are expressing when they cheer his murder. People correctly understand that Brian Thompson made millions risking the lives of other people for money. They hate that idea, and they hated him for it. The stats, the economics, the pearl-clutching over violence all-it all misses the point. Brian Thompson made people feel scared for their safety, and what they really want is for leaders to protect them, not lecture them on whether the chain of causality really supports a reasonable definition of killing in a system with lots of variables and intervening causes. The inability to understand this is why Democrats have lost mass support among working people, and is also a big reeason Trump won a second term.
You should post more often. This isn't to say that I agree with all of your arguments but I'm glad you're making your voice heard.
How is that different from what farmers do? Every time they try and charge more than what would keep they at bare subsistence they are cussing someone to go hungry.
I mean, not so much farmers because they were far away, but shop owners who were thought to raise the price of bread too high were frequently targeted during peasant riots. The difference is thankfully, thanks to advances in agriculture and heavy subsidization of the buying of food for poor people by the state, while there is hunger in America, basically nobody, outside of incredibly unfortunate cases of either homelessness or weird one-off cases, dies of starvation in the US.
Meanwhile, basically everybody is one or two people away from knowing somebody who was treated terribly by a health insurer.
Correct. And if farmers were getting millions in bonuses for driving the price of flour to $50 for a five pound bag and making people fear starvation or penury, then everyone would hate farmers and demand price controls. And it would be absurd to argue that it isn't a big deal because most people don't make their own bread at home, and carbs are unhealthy, and reducing grain production is good for the environment, etc. In the real world farmers, at best, make a reasonable profit and flour is readily available and affordable and we all accept the marginal tradeoffs.
Regarding crowds at the Vatican Museum, when I was there (admittedly a long time ago), focal tourist sites (think Sistine Chapel) were insanely crowded, but most of the museum was nearly deserted, though filled with fascinating and remarkable items of beauty and historical significance.
One more idea in a similar vein. Go in the off season.
Unfortunately, it’s the off season because people don’t have time to go then!
Of course I fortuitously had a work trip to Rome in January and experienced a nearly empty Sistine Chapel!
My recollection is that it had very small doorways between the galleries, which became choke points, especially for the crowds of tour groups.
Vatican Museum might be the only place I’ve been where the crowds were intense enough that I flat-out didn’t enjoy the experience pretty much entirely because of them. I was there in March, for what that’s worth.
I think Democrats should pay attention to groups like The Bulwark in deciding whom to nominate. #NeverTrump conservatives are a peculiarly valuable asset to the Democratic coalition because they have insight/instincts for what the public doesn't like about left-liberals and will naturally eschew it.
On the other hand, those are the people who thought Dick Cheney would be a useful endorsement.
Did you mean Liz Cheney?
Liz was more prominent, but didn't both of them give endorsements?
Yes, you’re right. Liz Cheney’s endorsement was a public event.
Speaking as someone who voted for Kasich in 2016.
Anti-Trump Republicans completely lost control of their own party after the Bush and Obama years. They failed to stop Trump and seem to have drifted towards Democrats on the basis of high-minded democracy issues, which mostly seem to motivate people who are already entrenched on one side or the other.
These folks are valuable, but they don't seem to have any particular finger on the pulse of actual swing voters from the last three elections, at least any more than other parts of the Democratic coalition.
I'm increasingly warming up to the idea of a Bulwarked Democratic Party with maybe a dash of The Dispatch mixed in. Of course, warming up to what is likely a fantasy isn't particularly useful.
I posted this in another thread here, but Tim Miller did what I thought was an interesting interview w/Newsom yesterday, especially the part about Charlie Kirk about 40 minutes in.
https://www.youtube.com/watch?v=frLiRbeuTpg
“Unfortunately, this may be the end of humanity.“
No, just a multigenerational replacement with more religious subgroups.
underrated comment here. If liberal/modern societies can't figure out how to have a stable population they will be replaced by illiberal ones that can.
Hungary: https://x.com/TPCarney/status/1998163872969085207?ref_src=twsrc%5Egoogle%7Ctwcamp%5Eserp%7Ctwgr%5Etweet
Russia: https://www.russiamatters.org/analysis/russias-demographic-vanishing-act-warning-history
China: https://merics.org/en/report/when-giving-birth-national-duty-beijings-struggle-reverse-demographic-decline
No, I'm thinking much more extreme. Basically theocratic regimes.
Maybe?
But on the other hand: https://www.aei.org/op-eds/irans-seemingly-unstoppable-birth-slump/
I was thinking more of sub groups within a population, not whole societies. Think Ultra Orthodox in Israel and US religious communities less exposed to the factors that contribute to population level birth rate declines.
That seems to be more a function of their poverty and low education, honestly.
“…US religious communities…”
Measles is going to get those folks.
Cortez and Pizarro conquered empires of millions with a couple hundred guys. The British ruled hundreds of millions in India with maybe hundreds of thousands. Israel dominates the entire Middle East today despite having 1% of the population of that region. Numbers just aren’t very important with technology.
And another out of Africa event.
Well, something like that... we've been down to around 60,000 individuals at some point right? We could potentially dip lower than the threshold at which those more religious subgroups (as we understand "religious") can't quite manage a stable population either, especially if they can't keep up with the agricultural production to sustain them.
A new equilibrium would be reached at some point; there's no reason to think that populations would keep ratcheting upwards.