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Lauren K's avatar

I think it’s entirely possible that Republicans would do more than chip away at the ACA if they win —specifically, reducing the exchange subsidies and cuts to Medicaid as pay-fors for tax cuts. I’m glad Harris talked about that at the debate— that it’s only because of the “late great” John McCain that you can still buy health insurance at all if you have a pre-existing condition. Would be good for Dems to keep hammering this I think.

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Ben Krauss's avatar

Dem frontline candidates are, but it’d be nice if the party as a whole talked about it more too

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NYZack's avatar

It's hard for me to find data about this, but I believe the pre-existing conditions benefit of the ACA is overstated.

Even prior to the ACA, I believe it was the case (point it out to me if I'm wrong) that if you could demonstrate previous and continuous coverage, a new insurance plan would not deny you coverage for pre-existing conditions. I know that this was always explicitly stated on new insurance plans I obtained when switching jobs.

If you could not demonstrate previous coverage, pre-existing conditions were excluded for a period of time (6 months, maybe?).

This is not so different under the ACA, under which you are expected to have continuous coverage, and, if you don't have such coverage, you have to wait until the open-enrollment period to sign up for coverage.

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Kenny Easwaran's avatar

It is a big difference though because a one month lapse in your insurance would lock you out of coverage for that condition forever under the old rules, while now it just locks you out until October of this year (unless you get a new job or spouse earlier).

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KetamineCal's avatar

While moving from college to med school, I needed temporary coverage to prevent a lapse of a few months. One company straight up denied me ANY coverage due to taking medication for depression when I was a teenager (just routine outpatient treatment) and I had to submit tons of records to them. The old system was absolute shit.

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NYZack's avatar

I'm not saying the ACA didn't make any changes. But (at least in my experience) you weren't locked out for pre-existing conditions forever. It was for some period of time (I recall, perhaps inaccurately, 6 months).

Under the ACA, if you get hit by a car in January without coverage, you are SOL for a long time, which might as well be forever. ... Which is why you should never be without coverage, before the ACA and after.

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James C.'s avatar

Where are you getting this from? I remember my mom either being unable to get insurance or being offered an absolutely absurd premium due to something from over a decade prior. I'm open to being wrong, but please come with some evidence.

edit: ffs, it only takes one quick search to find this, which says average denial rates were 18% and there were long lists of conditions, medications, and even occupations that led to automatic denial. In addition to that, "In 8 states and DC, conditions that existed prior to the coverage effective date – including those that were undiagnosed and asymptomatic – could be considered pre-existing and so excluded from coverage under an individual market policy."

https://www.kff.org/affordable-care-act/issue-brief/pre-existing-conditions-and-medical-underwriting-in-the-individual-insurance-market-prior-to-the-aca/

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NYZack's avatar

So here's an oblique reference to the previous-coverage issue in the reference you cited:

"About half of the states required individual market insurers to reduce pre-existing condition exclusion periods by the number of months of an enrollee’s prior coverage."

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NYZack's avatar

As I wrote in my comment, I find it hard to find data, but my own experience (maybe it was my particular employers or maybe it was NY state) reflected what I wrote (changing employers 3 times).

It's totally possible that this was idiosyncratic, which is why I asked that it be pointed out to me if I'm wrong.

The commentary I have read (including, I believe, the reference you cited, though I haven't read the whole thing) elides the fact that coverage of pre-existing conditions pre-ACA required proof of previous coverage; in many cases, they didn't exclude pre-existing conditions altogether.

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James C.'s avatar

Okay, I've found a bit more. HIPAA from 1996 did indeed cover what you're talking about. The issue with my mom might have been right around this time or maybe she had a gap at some point (I don't remember for sure). It was still a very precarious situation for people to be sure.

https://en.wikipedia.org/wiki/Pre-existing_condition#Former_regulation

https://kffhealthnews.org/news/did-the-aca-create-preexisting-condition-protections-for-people-in-employer-plans/

https://www.quora.com/How-did-people-with-pre-existing-conditions-get-health-insurance-before-ACA-Was-the-process-easier-if-you-switched-from-an-employer-s-insurance-to-private-due-to-job-loss-for-example-as-long-as-you-maintained-that

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Kenny Easwaran's avatar

I was under the impression that pre-ACA, if you were diagnosed with hiv or with diabetes during a period that you didn’t carry insurance, then new insurers would not cover treatment of those conditions (which makes sense if we think of it really as insurance, where it is aiming to pay for unknown risks, not known costs).

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ML's avatar
Sep 14Edited

Prior to the ACA it was legal for an insurer to deny coverage entirely, or to deny coverage for a pre-existing condition —- period. Some employer plans acted like you describe, but it was entirely voluntary based on what the employer contracted for. If you were in the individual market you were simply screwed. You could also be charged an entirely different premium based on your medical history — forever.

There may have been some state specific laws that provided more protections.

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Eszed's avatar

This is going back 20+ years, but the law at the time in California was (if I recall correctly) that companies couldn't entirely deny coverage (maybe only if there hadn't been any gap, which there wasn't in my case), so - based on my pre-existing condition - I was given quotes for $9,000 per month.

Fortunately, California had a state-subsidized last-resort program for people like me, and I paid $400 / month to Blue Cross for crappy coverage.

I thought the ACA was an awkward compromise, but it was a darn sight better than the status quo. In fact, I was living abroad at the time it was passed, and would not have considered returning to the USA had it not.

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Binya's avatar

I think it's false that Republicans "don't have an affirmative governing agenda". The project 2025 report is 900 pages long, and the article notes Republicans have a big immediate priority in extending the Trump tax cuts. They're running away from their agenda because it's unpopular, not because it doesn't exist.

Also, if Republicans ride any one thing into the White House, I'm pretty sure it won't be a thermostatic shift. A party regaining the WH the election after losing it has happened only twice since WW2, indicating thermostatic shifts are weak (especially as both those times, '80 and '20, saw incumbents burdened by some very peculiar liabilities). If Harris loses, IMO it'll very likely be due to the biggest bout of inflation in 40 years.

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John E's avatar

I disagree. Project 2025 is about as much the Republican/Trump governing agenda as a similar document created by the Center for American Progress would be for Democrats/Harris. The difference is that Project 2025 fills the void because Republicans don't really have a governing agenda, while Democrats/Harris do have a governing agenda independent of a third party org.

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Milan Singh's avatar

Disagree here. P2025 was created by a bunch of ex-Trump staffers. Trump himself spoke at an event hosted by Heritage and praised the plan. Vance blurbed Kevin Robert’s, the head of Heritage’s, new book. Roberts has flown on Trump’s plane.

Trump and Vance will pretend they have nothing to do with P2025 because it’s weird and unpopular. Trump says the same thing about Dobbs. But the evidence is right in front of our eyes.

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John E's avatar

I’m not saying there isn’t overlap, just like there are probably many policy positions put forward by CAP that are similar or endorsed by Harris. My point is that I would *almost* be happy that 2025 was a governing agenda because it would mean that Republicans might be shifting out of a pure grievance based approach. You can negotiate policy - see the recent podcast between Ezra Klein and Oren Cass. But you can’t really negotiate grievance, it’s just destructive. But a Trump led Republican Party isn’t about policy, it’s about grievance.

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TR's avatar

I wonder how much of it is leaning into grievance because they don't care about policy, and how much is leaning into grievance because they have a policy agenda but know it is unpopular? I think they both exist, but with different people -- e.g. Trump may be more interested in grievances than any particular policy agenda; the authors of Project 2025 care about policy but want to do things that only a fraction of Americans want and that most would not materially benefit from; other Republican politicians may be in between. Some have policy ideas, some don't, none have policy ideas they could win a national election on, so they decide it's best not to call attention to policy in their campaigns.

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John E's avatar

I think this is a good point. The key is that there are very divergent preferences still within the Republican Party that have not reconciled at any level. Democrats have disagreements with the left, but within the party there is actually a substantial amount of elite and base agreement. Meanwhile, because there are so many disagreements within the Republican Party, it’s increasingly difficult to build a cohesive policy agenda and therefore the reliance on grievance to win against Democrats. But if the Republicans win a majority, they are unable to forge a workable compromise within the party - the current house majority being a prime example.

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TR's avatar

Interesting. This sounds correct -- the Republicans have lots of infighting, and have been ineffective in passing legislation even when they had a trifecta in 2017.

But at the same time, I also hear left-leaning sources opining the opposite, that the right always lines up behind their leader and the left is always split by infighting. Maybe this perception comes from "outgroup homogeneity bias"? Some of the people I've heard it from lived in Europe. Or, in the US context (and maybe analogous things in other countries?), the relationship to the base is not symmetric on left and right -- the Democrats respond to more movements without clear leaders, so negotiations with the base look more like public pressure and less like private meetings with elite movement leaders and megadonors.

In terms of being able to agree on a policy agenda, I think you're right that the Democrats are significantly more united, and perhaps more interested in doing something as a government, compared to the Republicans. But I also find it interesting that I've often encountered the opposite perception in my left-leaning social group.

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Sharty's avatar

I would like to word-nerd for a moment.

> Many of these candidates have clear pro-life track records, which they don't want to highlight in an election climate where pro-choice politics are more salient than ever.

"Salient" does not simply mean "relevant" or "important", although it is often used this way (and that's not really wrong). Etymologically, it means to project or protrude.

You will commonly see descriptions of a "salient" in the context of relatively static trench-like warfare. It describes a bulge of your lines into the enemy front, where you have maybe made a substantial tactical gain but have now subjected forces within the salient to attack from three sides. If you want to gain ground, unless you can somehow have your entire front advance in lockstep, you will necessarily establish temporary salients here and there. But they're dangerous once you have gained them. It's a give and take.

Anyway, "salient" is a good word.

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Ben Krauss's avatar

Noted!

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Sharty's avatar

I should have been explicit that I think that "salient" is actually the more correct, more expository word to use here, rather than "relevant" or "important". Republicans stuck their neck out and got (at least for now) something that really mattered to them. But the gain brought associated risk.

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ConnieDee's avatar

Hooray for the word nerds! Since I'm working on my Spanish right now, I'm aware of the ultimate root "to spring or leap" from Latin "saliō." We have the the verbs saltar in Spanish, sauter in French and saltare in Italian.

Certainly immigration and abortion are jumping out at voters on both sides. We can even close the linguistic loop back to saute and get images of these issues jumping around in the frying pan as it heats up.

T

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Ethics Gradient's avatar

Is this the origin of “sally forth?”

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ConnieDee's avatar

Why yes it is, according to Wiktionary:

Etymology 2

Borrowed from French saillie, from sailli, the past participle of the verb saillir (“to leap forth”), itself from Latin salīre (“to leap”).

sally (plural sallies)

A sortie of troops from a besieged place against an enemy, a sudden rushing forth.

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Lapsed Pacifist's avatar

And they would sally forth from a 'sally port', which is a small, easily defended exit in the exterior walls, usually set opposite other main entrances.

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TR's avatar

Also "salir," to go out. I'm no expert on the etymology, but that sounds more like "salient" (or Latin salio/salire) than "saltar." Though from Wiktionary, "saltar" may be related to the fourth principal part. https://en.wiktionary.org/wiki/salio

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Lisa C's avatar

This is so interesting! I always assumed “salient” came from a derivative of the root word for salt, as in, when you boil down sea water the remaining, relevant content is sea salt.

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ConnieDee's avatar

Salt appears to have its own roots going way, way back, which is why I love Wiktionary. I had to click through to the Latin to get to this: Cognates include Sanskrit सर (sará), Old Armenian աղ (ał), Ancient Greek ἅλς (háls), Tocharian A sāle, Old English sealt (English salt), Proto-Slavic *solь and borrowed into Etruscan 𐌀𐌋𐌑𐌀𐌔𐌄 (alśase)

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John Freeman's avatar

Reading about a Republican saying that he's for "protecting our Social Security and Medicare, and lowering the cost of our prescriptions" it occurred to me: in this hyper-polarized environment, it's a lot more powerful if a politician takes a stance typically associated with the other party. E.g.: if you were worried about gun rights, would your ears prick up more if a Republican candidate said they'd do everything they could to stand up for the Second Amendment, or a Democratic candidate did?

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Milan Singh's avatar

Publicly and loudly with your party on an issue where the other side’s stance is popular…if only someone had coined a term for this technique.

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Randall's avatar

I agree. I actually think it would be wise for individual candidates in both parties to highlight popular positions where they differ from what is associated with their party. May cause some coalition problems later, but it’s a smart way to win an election. Establishes some independence from the knee jerk tribalism that I think is a turnoff for cross-pressured swing voters.

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Joachim's avatar

That has always been the case. It's also a plus if you superficially look like (dress like) a politician from the opposing party, e.g. Jon Tester, Tim Walz.

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ConnieDee's avatar

Just read the NYT review of STOLEN PRIDE: Loss, Shame, and the Rise of the Right, by Arlie Russell Hochschild - it affirms what I already figured out years ago, mostly by paying attention, but also from a couple years living in Trump country. When people, especially men, don't have well-paying jobs that allow them to fulfill the purpose of taking care of a family, they can be damaged psychologically. The book review explains how Hochschild ties this to the anger and blaming that Trump and Vance pander to. (The anger is understandable: it's natural for humans assume a zero-sum game when someone else gets more than we do.)

But do the Republicans ever actually address the deep need for sustainable jobs or the basic human need to have some pride in one's own life? Nope, Trump just triggers people's anger. Vance gives the message that having a good little woman at home and making all those Other People abide by his (mostly sexual) morality (which leaves out honesty) will somehow lead to something - certainly not fulfillment.

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srynerson's avatar

"When people, especially men, don't have well-paying jobs that allow them to fulfill the purpose of taking care of a family, they can be damaged psychologically."

The problem I have with this sort of explanation is that's it's like somehow the last 50 years didn't happen and the US of the 2010s was indistinguishable from the US of the early 1960s in gender roles, race relations, etc. I mean, someone aged 40 or younger has lived literally their entire life in an American society that has had an explicit and near total institutional -- both governmental and (I'd argue more critically) cultural -- commitment to gender and racial equality, and someone aged 41 to 55 got to watch that transition play out in their childhood to early teen years. No American man under the age of *65* has spent any part of his adult life living in an American society where "The Man is the Breadwinner and the Woman Stays Home!" was the dominant message being delivered -- that was dead by the mid-1970s -- and it, in fact, feels like gaslighting (a term I generally find far overused) to claim otherwise.

I will stress that I'm not picking on you with this critique! It's a reaction to this genre of political writing that acts like the US in 2010 was indistinguishable from "Leave to Beaver."

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ConnieDee's avatar

Culture does not automatically change because of some kinds of "dominant message," and human nature underlies culture, evolves more slowly, and is prone to regress.

It goes down to the way we've evolved psychologically. (Yep, I believe we are hard-wired along gender-based spectra.) Many women have a kind of automatic purpose in life because they find themselves with offspring to care for. They can work at home raising kids without agonizing over their purpose in life (although they may be bored out of their minds.)

In the meantime, there are plenty of American men under the age of 65 who are in families with an unbroken line of gender roles and/or in jobs where women are still sexually harassed or just not respected by their male colleagues. It's not just sexism - it's also why we still have racism and general fear and hatred of People Who Are From Other Tribes. The "Leave it to Beaver" political writing does not drive this - it just mirrors aspects of human nature that are always there to be exploited.

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Sean O.'s avatar

Doesn't it matter that Republicans actually won the major battle over Obamacare? Republicans repealed the individual mandate to have health insurance, and Democrats aren't fighting to bring it back. It seems like Republicans have taken the dub and moved on.

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James C.'s avatar

That presumes the mandate was what they actually cared about; they should have claimed victory if that were true. I don't think it was at all that coherent - it just became a shibboleth for the right.

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James L's avatar

Depends how you look at it. They won that battle, but they lost the war to repeal Obamacare.

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ML's avatar

My understanding of the evidence is that it turns out the individual mandate turned out not to matter that much in terms of getting/making people sign up, nor in the financial health of the plans.

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Marc Robbins's avatar

It turns out that the individual mandate wasn't that important.

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Kenny Easwaran's avatar

That was actually Obama’s plan if you recall the debates he had with Clinton in 2007. Everyone thought you needed a mandate to prevent a price spiral due to adverse selection, so everyone thought Obama’s plan was a bad one, and Obama gave up on it when he was getting it passed. But the Supreme Court gave it to him anyway, and against all odds it seems to be working.

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NYZack's avatar

But it's likely one reason premia are higher than they would otherwise be.

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Tom Hitchner's avatar

Who was it I was talking to here who said that Republicans actually won on the issue of gay marriage, because it enshrined marriage rather than maximal libertinism? I don’t think I buy either of those lines but I’m certainly not going to stop people from making peace with the situation.

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Brad Foley's avatar

All well and good... fentanyl bad .... border policy, abortion, sure

But I can't get past the swipe at Knives Out. Daniel Craig, chewing the scenery in fancy duds, with an intricate and outrageous plot, is a steal at any price. I would vote for whichever party chunked those movies into fifteen second clips and ran them as political advertising.

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Dan Quail's avatar

Omnicausers really hurt the GOP by self immolating.

The GOP used to point to that folks and label all Democrats with their radicalism so that Republicans look more moderate.

Months of Omnicausers screaming “genocide Joe” and driving people away from the left political ecosystem that glommed onto the Gaza conflict makes Democrats look more moderate. It also robs Republicans of the strategy to tie Democrats to defund the police, wokeness, student loan forgiveness , etc because many of the advocates of said policies jumped on the omnicause bandwagon.

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Binya's avatar

If Democrats win the election by nominating a candidate so old he has to drop out with months to go PLUS having their fringe "self immolate" that will certainly be something.

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srynerson's avatar

Eleven-dimensional chess!

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drosophilist's avatar

“It also robs Republicans of the strategy…”

Not that Ross Douthat isn’t trying in today’s NYT.

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Tom Hitchner's avatar

I like Ross when he’s writing about, like, Lord of the Rings or Watership Down, or relatively nonpartisan issues like gambling and architecture. But when he writes about elections he’s just as dishonest as Kristol or Stephens were in the pre-Trump days. For instance, in today’s piece you references, he says the last four years have seen woke incursions into institutions, ignoring that that incursion started ten years ago, greatly accelerated under Trump, peaked in 2020, and has been on a slow recession ever since. His mission is to give permission for people to vote for Trump, all while supposedly staying above that task.

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drosophilist's avatar

+1000

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John E's avatar

I'd be interested to see how these patterns work over time. My expectation is that the party without the presidency tends to use attacks ads much more heavily. Would also expect Republicans as the (supposedly) conservative party to use them more as well since they will be attacking changes that the more progressive Democratic party is pushing.

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Ken "The Chef" Flowers's avatar

I wouldn't call feeding xenophobia & nativism "moderating." Neither party is anywhere close to, you know, the Statue of Liberty on the subject, nor have they been in my lifetime. The only recent observable change is that Democrats have become a little more nativist as an attempt at triangulation.

It's telling which issues they'll triangulate on & which they won't. Newcomers - tempest-tossed - meh, appropriate subject for triangulation. The ***** subject? Never. Why? They're dramatically out of step with Europe now, especially on the subject of ***** kids.

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Ben Krauss's avatar

I’m very unsure what this means

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James L's avatar

I don’t know what ***** means, but I suspect it is something ugly. Regardless this comment is probably unpleasant and definitely incoherent.

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Sharty's avatar

"Probably unpleasant and definitely incoherent" was the final line of my last performance review

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Randall's avatar

And yet, you just mounted a very coherent explanation and defense of how “salient” should be deployed! Maybe your boss is incoherent.

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James L's avatar

Probably time for a new job...

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Sharty's avatar

The alternative comment was "such-and-such good band name". I just wanted to recognize an excellent (and correct) turn of phrase.

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Randall's avatar

"Probably unpleasant and definitely incoherent" Is the name of my Radiohead cover band.

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James L's avatar

Got it, thanks. Allow me to compliment you as well on your effort crafting well written posts.

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drosophilist's avatar

Tango Romeo Alfa November Sierra

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James L's avatar

Ah, thanks for explaining. There are a lot of potential five letter words there.

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James C.'s avatar

I've been wondering if this is the new spiky since he started appearing. It's just different enough that I'm not convinced, but it does have a mix of coherent and incoherent posts. Only look at his substack if you dare.

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Sharty's avatar

Spiky made excellent points from time to time, albeit the signal-to-noise ratio was quite poor. This is just... not that.

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Seneca Plutarchus's avatar

Gee I wonder what the US is medically out of step with Europe with in regards to kids.

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James L's avatar

Uh, vaccinations? Prenatal care? Infant mortality? Preschool approaches? Corporal punishment? Phonics? I can think of a million things.

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Milan Singh's avatar

One of the reasons Lincoln won in 1860 was that he was seen as a moderate on slavery. If you read his speech on the Kansas-Nebraska Act in Peoria he does quite a bit of the sort of moderation you’re implicitly condemning as wrong. He goes so far as to explicitly claim to be opposed to equal citizenship for Black people, and says even if he supported it, it would be a nonstarter since the majority of white people oppose it.

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avalancheGenesis's avatar

Didn't the 2022 midterms demonstrate that while ***** has a lot of high-salience cultural staying power, it just didn't perform too well as an actual vote-getter (or vote-loser) when the road hit the rubber? Makes sense not to bother triangulating if it won't really shift outcomes. Perhaps this will change in the future, when more immediately-pressing concerns like inflation fall out of the Top 5, and the parties go back to primarily slugging it out over culture war stuff...

And I say that as a ***** who's rather not on board with the general Democratic consensus on the issue anymore. It's Not Great, Bob, but there are simply bigger fish to fry right now. Tariffs > *****. Or, heck, even in the other direction, taxes, if we're sticking to starts-with-T issues. Immisseration "disproportionately affects" ***** kids, after all.

As an aside, ***ing an obvious word as a figleaf stylistic indication of one's distaste is about as subtle as the old (((markup))). This isn't FdB's blog, no need to beat around the bush with what you mean.

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John Freeman's avatar

Wow.

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Just Some Guy's avatar

Speaking of Don Bacon, he's cosponsoring legislation which would hopefully make kidneys more available. Sometimes congress functions!

https://x.com/RepDonBacon/status/1833927860601462914?t=pKjuMQ-pK_9Fa6l9BvSXHg&s=19

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Andrew's avatar

Does nypd only make the word cloud because a lot of frontline members are fighting in greater nyc or is there some ny

Metro story running as national news I missed?

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Ben Krauss's avatar

Anthony D’esposito is a cop and he said it four times across several ads. Then one other NY state legislator said it

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Seneca Plutarchus's avatar

Because the Commissioner just resigned in a corruption scandal?

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Red's avatar

NYC scandal. Police commissioner just resigned. Maybe that's why.

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UK's avatar

Yes. Very confused why it’s showing up

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User Team's avatar

Ben, well written, researched and informative article. Like the comparison between the Republican attack ads as a waste of 450 million to Netflix buying the Knives Out sequels.

Proud grandparents of Ben

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Joachim's avatar

If Dems are smart and neutralize the immigration and law enforcement issues by tacking right on both, Republicans have nothing left to run on that is attractive to independent voters.

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