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Kevin's avatar

Some activists are more interested in displaying their righteousness for the benefit of their peers rather than winning.

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David Abbott's avatar

Being admired and getting laid are achievable goals. Big, institutional change in the face of an antiquated constitution is hard.

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dysphemistic treadmill's avatar

"Being admired and getting laid are achievable goals."

Ha! Must be nice being you....

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mathew's avatar

"Big, institutional change in the face of an antiquated constitution is hard"

That's a feature not a bug.

Big changes should have large bi-partisan support. And if it's not constitutional, then it should require a constitutional amendment. Rule of law is always a good idea

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Dan Miller's avatar

How's that working out for us? Does the United States seem like a particularly functional or governable polity? Is our public policy the envy of the world? Are other nations clamoring to copy our 60% approval threshold for major legislation, or our malapportioned upper chamber?

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evan bear's avatar

It's difficult because there are clearly certain life situations where a moral calculus that sort of resembles this is the right one, so people's internal compasses get confused. For instance, if you're told that if you want to advance in your job you have to (1) stop associating with embarrassing friends or family members, (2) pretend not to hold political or religious views that you actually do hold, (3) praise and fawn over bosses whom you find distasteful, (4) publicly downplay some morally repugnant things your industry does, (5) etc. - then the right moral decision may in fact be to sacrifice your job and find another one, even if your family suffers economically. So a lot of people start to incorrectly intuit that "staying true to yourself" is the value you should always maximize to the exclusion of all others.

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evan bear's avatar

Reflecting on this some more, I'm thinking there doesn't have to be a conflict between "staying true to yourself" and winning. The key is just understanding that politics is a team sport and embracing the underlying principles and logic of a democratic system of government. You don't have to deny that you want things that you want. You just need to make a conscious decision to defer, and say that you're deferring, to other members of the coalition when you collectively decide on a platform, because that's what it means to be part of a team.

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Kade U's avatar

Some (many?) even believe that 'winning' is an ambiguously violent revolution which overthrows capitalism, and that any policy change is only really important insofar as it builds old-school Marxist style class consciousness to prep for the revolution.

I think people are really underrating to what extent the activist class has been captured by actual real life communists because we are so used to listening to Fox News complain about non-communists being communists.

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David R.'s avatar

No.

The post to which you’re replying is spot-on, borne out by the demographics of the activist class, their positions, and reams of anecdotes in this Substack.

In contrast, there’s no evidence at all to support this contention.

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evan bear's avatar

There are some people on Twitter who like to cosplay as anti-electoralists, but Twitter is not real life and in any event, even they are not sincere.

People with actual jobs on campaigns or activist organizations are not like this. They are just naive idealists who get blinded into thinking they have the votes.

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Kade U's avatar

Here are three points I would make, then.

1) Any cursory trip through humanities academia and prominent journals will reveal that most professors at elite universities who teach humanities courses are, at the very least, in a primarily anti-capitalist and Marxist-inspired milieu. Whether they openly discuss revolution varies, but one wonders how exactly they anticipate the current order to be overthrown.

2) Most of the language that filters through the activist sanewashing machine starts with actual communists. Police abolition begins not as a typical progressive activist class position, but rather was a deeply radical position held by actual anarchists and communists many years ago. Because the social cachet of these people has become so prominent on the left, even non-communists end up adopting their ideas and language and simply changing the actual policies to be less insane. But those people are still there, and they are the ones pushing their fellow-activist friends to be crazier and crazier.

3) Random college activities that used to be the places where activists were born, such as debate clubs, have almost completely been overtaken by actual communists. Spending literally any time at CEDA or NDT today (major debate tournaments for college students) will have you running into dozens of sincere communists who will openly tell you they intend to start a violent revolution at the earliest opportunity. This is a radical change from even 10 years ago, where the communism was mostly strategic and tongue-in-cheek, not sincere.

Maybe I'm being paranoid, but I really think that this is an actual issue. I'm not claiming that 50%, or even 30%, of progressive activists are communists. But I think the real number is probably in the 10% range, which is a HUGE number of people.

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David R.'s avatar

These are, I’ll note, assertions and not evidence, but I’ll take that last sentence at face value nonetheless: How many “progressive activists” do you think there are?

My guess is maybe 200,000 nationwide. 10% of that is 20,000, which is about the membership of the CPUSA in 1945.

The threat level hovers between “nonexistent” and “what are you smoking?”

Look, if the GOP fears an actual leftist revolution, it should be acting very differently, like the US did in the 1930’s. File the rough edges off of capitalism, restore faith in government by actually acting in the best interests of the electorate, and work to head off the foreseeable problems of the future.

Because the only way that revolution happens, let alone succeeds, is if life gets a lot worse for the great majority of the country.

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Kade U's avatar

To add (sorry, just thought of this): remember the book "In Defense of Looting" that was a big deal on the left during the summer of 2020? It literally, explicitly makes the argument that the left must use violence to fight "racial capitalism", and actively denounces non-violent resistance. I do not know how you could get more obviously-communist than that without directly saying you want a vanguard party to establish a dictatorship of the proletariat.

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elm's avatar

How many people actually read that book, given how low sales of books are? How many people who might do a surface reading of that argument would then agree that they want to establish a dictatorship of the proletariat (nearly none of them, I expect)?

How many republicans are actively trying to establish a one-party strong man government right now? How many old people on facebook are essentially getting their information from Russian and Chinese influence programs (which are pushing them to the hard right)? Hell, how many American Democratic senators are being driven by various disguised hard right forces?

I lived through 1980's and I remember knowing people who were actual communists at the time, strongly supportive of the Soviet Union (sometimes China), and the number of those people was pretty small and they vastly outnumbered the people who are actual tankies right now.

I am pretty sure the hard right (neo-nazi right) massively outnumbers any actual communists in the American population.

elm

why are you carrying water for the glenn becks of the world?

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Kade U's avatar

Sure, it's not evidence, mostly because it's difficult to determine how many people are actual violent old-school communists and how many people are the "socialists" that actually just means social democracy. There's no real way to be objective about this even if I had the time to go digging for more concrete evidence.

But to be clear, I'm not a Republican, and I have no real concern for what the GOP thinks or doesn't think. I also don't fear a communist revolution.

What I do fear is that, if communists are the ones setting the agenda on the farthest-left parts of our party, and are deciding what issues the progressive left decides to champion (looting is Good, Actually; we should get rid of both prisons and police; violent riots are not that big of a deal if the cause is just, etc.) then we have a goal misalignment problem. For a communist, electoral victory for AOC-like politicians is almost counterproductive. For them, it is about generally undermining faith in the system that presently exists to create the conditions for revolution. They will almost certainly not succeed in actually causing a communist revolution, but they can certainly do damage and steer the progressive left away from its most popular ideas to extremely unpopular ones.

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Sobopla's avatar

>Any cursory trip through humanities academia and prominent journals will reveal that most professors at elite universities who teach humanities courses are

Awww I call bullshit. Why not redbait the social scientists or the STEM divisions instead of picking on the arts and literature folks? If you think that the humanists are going to overthrow *anything* with violent revolution you haven't been on campus at one of those elite universities that you speak so confidently about.

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David G's avatar

You are being paranoid. I don't know what you mean by a 'Communist' other than someone who disagrees with you. I haven't met one in real life in the US despite living here 69 years. Must be cells of them all over if they're 10% of the population. How did I miss them???

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Kade U's avatar

10% of the activist population, not the general population

i.e. on the order of tens of thousands, not millions (i mention in another comment I am less concerned about an actual revolution than I am about it making the activist class do bad politics)

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Sep 22, 2021
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Kenny Easwaran's avatar

Why think the tweets are more revealing than the published work? I would think the tweets are a series of clever postures, while the published work represents the more considered view.

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Sep 22, 2021
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Kenny Easwaran's avatar

My impression is that published work is how they act at work, and tweets are what they tell their friends they were doing at work.

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Charles Ryder's avatar

Activists simply don't have the same day to day incentives as, say, the chief of staff of a Senator or House member (or their campaign chair, or a high level staffer at the DCCC, or what have you). In most cases it's not "for the benefit of their peers" in the case of these activists (or digital media people, or Twitter influencers, or what have you) but their own careers or jobs. In most cases (assuming we're talking about people on the left) they're going to prefer that Democrats, rather than Republicans, win elections, of course, but it's not the *central focus of their jobs* the way it is for the people in the elections trenches. Which yes, can cause problems for Democrats, because "activists" influence what the media covers. And what the media covers matters. A lot.

(Republicans aren't immune from this dynamic, either, naturally; I have a feeling people like Mitch McConnell and Kevin McCArthy aren't totally pumped for the specter of Texas abortion bounty hunters.)

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David Abbott's avatar

on the other hand, performative wokism only works in intra-progressive status competitions because a lot of progressives go for it. without the likes and retweets, without the demand for doctrinaire content, there would be much less supply.

at a minimum, a significant number of media consuming progressives enjoy wilke performances.

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David Abbott's avatar

*woke performances

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srynerson's avatar

I agree with most of this, but I think the problem is deeper in that, over the past 5 years, a substantial part of the progressive movement has increasingly not just failed to have the fact that the the median voter is a 50-something white person who didn’t go to college and lives in an unfashionable suburb in the front of their mind, but to actively seek to do things that aggravate someone fitting the profile of the median voter for very little practical gain. (See, e.g., anything involving pronouns -- even the vast majority of LGBTQ individuals use traditional pronouns, so you're talking about trying to get 99%+ of the population to rethink the manner in which they've been speaking on a daily basis for basically their entire lives for the sake of making a fraction of 1% of the population more comfortable.)

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Sharty's avatar

It feels like "delete Twitter" covers 90% of the actionable problems here.

I remember, 1000 years ago, when WarrenSanders was abuzz all over the internet and then Joe Biden went and talked with regular-ass people and then crushed it! And almost nobody learned anything.

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David R.'s avatar

If I were either a candidate or running a campaign, I’d have three post-it’s on my staffer’s desks.

1. Anyone who frames a bread-and-butter issue in “equity” terms will be fired.

2. More and better police, not none.

3. All press interactions must be delegated upward.

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srynerson's avatar

I agree with point # 1 so much I just came here 2.5 years later to confirm that!

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Ted's avatar

Point 3 is a recipe for letting your opponent define your campaign before you can sit down to breakfast.

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Sep 22, 2021
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Tyler G's avatar

The difference is you're basically in the manager's seat for democratic staffers -- you have stuff that you want them to accomplish that's more important to you than the stuff that you like about labor protections. At, say, a McDonalds, you don't really benefit from high team member performance, management control, or whatever, so it's easy for you to support the staff members themselves over their manager's goals.

I think this is why liberals carve out Police from "unions they want to protect", and Conservatives really only support unions for the police, even though those positions are mostly incoherent with regard to unionization itself. It's also why I generally support the existence of private unions, but not public unions - since the broader public has much more interest in "employees being accountable for doing a good job" in the latter.

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Kenny Easwaran's avatar

One excuse I have for being in favor of private sector unions and against public sector unions is that at least public sector employees still have a say in management through voting, whereas private sector employees don't typically have any say in their management unless they are shareholders or in a co-op.

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David Rye's avatar

I think the other factor is private sector unions also face competitive market pressure - so there's a countervailing force to the negotiations that doesn't exist with the public sector (e.g., tenure based layoffs in a private sector downturn will actually further constrain operating margins leading to a downward spiral).

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dysphemistic treadmill's avatar

I saw a quote yesterday -- maybe in an LGM comments thread? -- from someone in the military service during the Cold War, talking about the relatively autocratic and hierarchical nature of military authority, saying "we're here to defend Democracy, not to practice it."

I don't think that's incoherent. So, I don't think it's incoherent to ask people fighting for greater unionization to do without certain protections or to tolerate less than ideal working conditions

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Henry's avatar

Was reading a book on the Civil War, and one of the oddities of the Confederate army is that they did practice democracy, with officer elections. So did the Russian army for a little bit after 1917. So it's not totally impossible or unheard of.

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David R.'s avatar

I see no incoherence here. These people are basically poorly paid volunteers; there’s always going to be a big difference between a career and a vocation.

Also, more prosaically, no worker protections will ever cover incompetence, except incidentally to other goals, so I have no moral trouble supporting easy hiring and firing for competence issues alongside a decent standard of evidence to prevent that from being a figleaf.

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rosaz's avatar

Campaign staffers are a great example of why evidence requirements in competence-based firings are so messy. Let's say you manage campaign staffers. One tweets something from the campaign account that is (to your mind) obviously damaging to the candidate. But if you fire them, and end up in front of a jury or judge (in a blue city, in a purple state) that agrees with them, not only is the campaign liable, but as you as the manager can be *personally liable*. Is that really a risk you take?

While firing anyone for nonsense reasons is obviously abusive, having outsiders who don't understand the industry or the role try to quickly gauge what competence looks like puts companies and individual managers at great risk whenever they fire, even in very real cases of incompetence.

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David R.'s avatar

I think the goal of any employment protections shouldn’t be to force an employer to prove incompetence, but to dictate a relatively low bar for an employee to show probable cause that the issue was not incompetence.

Keep the burden of proof where it is, but lower it, if you will.

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David Abbott's avatar

fair point and campaign workers do get treated like shit, mainly because a lot of idealistic young people want to do it (until they get burned out).

thing is, campaign workers are like 0.01% of the US workforce. I’m willing to tolerate bad conditions in campaigns to help the other 99.99% if they economy, and I don’t feel guilty about it. Soldiers in combat have much worse working conditions, even if their boss never grabs their ass.

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MJS's avatar

This is also the paradox of police unions. In theory, we should like unions, but when their main function is to protect the jobs of people who really need to be fired, they're rather toxic.

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Sep 22, 2021
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Clifford Reynolds III's avatar

Progressives are also in favor of economic redistribution, which helps working class whites

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Sep 22, 2021
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REF's avatar

Ridiculous assertion...

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Sep 22, 2021
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REF's avatar

Your previous statement was: for all values of (A) and (B) the country is worse off. I maintain that statement is ridiculous.

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Jack Henneman's avatar

FWIW, I think that our public health community would have done well to put up that Post-It Note(R) in the last twenty months or so. For example, a lot of smart highly educated people thought it was important to suspend the JNJ vaccine because there were six serious adverse events out of seven million injections. They (and a lot of academic physicians) thought that adhering to the "process" would boost the credibility of the vaccines. I think the median voter, a bit short on statistics training, heard instead that "six adverse events out of seven million is a good reason to suspend a vaccine." Vaccinations literally peaked the day of the suspension, and fell like a stone in the months thereafter, which clearly was the opposite of the reaction anticipated by the FDA. I think we would have had a better outcome if more people at the FDA and CDC had grown up spending their summers on the Gulf coast or the beaches of Lake Michigan rather than the Atlantic coast, or at least reminded themselves that the median American lives far outside their assumptions.

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JA's avatar

I agree with Matt that it's pretty astounding how much Democrats message as if they don't know who the median voter is. If you listen to Dem candidates and read any mainstream (non-Fox) media, you'd think that for the Democratic establishment, the issues facing "people of color" in any country on earth are more important than the issues facing the median 50-year-old white voter in the U.S. That's just bad for winning elections.

I wonder about two things, though. First, how much of this is the incentives of Democratic political operatives rather than forgetting who the median voter is? I could imagine that if you're a staffer for a Democrat, you could be socially punished in some way for expressing too much concern for the median voter.

Second, how much of Republicans' success is due to negative (rather than positive) polarization? I don't think swing voters who went for Trump really thought Trump cared about them. However, he did rail against the New York Times, MSNBC, etc. (i.e., the people who constantly talk down to the median voter). If the problem is negative polarization, the Democrats might not solve the entire problem by acting like they care about the median voter. They'd need to speak out against coastal elites to a greater extent, which is probably impossible given funding constraints.

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David R.'s avatar

The number of times a perfectly populist (and popular) stance on the issues has been ruined by unnecessary IDpol framing is… terrifying.

I’m much, much more political (and rather more partisan) than the average American, but I’m at pains to remember that every time I get caught up in a conversation about politics and try to tone it down lest my companion get, well, bored.

If everything I do is framed as a racial equity issue, everything I do will be unpopular even if it’s actually popular.

And the godforsaken news media is *not* helping.

I think the fundamental issue, or hole, in Matt’s thesis is that the median reporter is far, far more disconnected from the median voter than the median Democratic Party staffer.

Short of “First, we kill all the press”, I just don’t know how to solve that problem.

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mark robbins's avatar

And the overwhelming majority of those "people of color" do not refer to themselves as "people of color" so when you talk like that they immediately tune you out.

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Ted's avatar

I suspect that gerrymandering has something to do with this.The national median might be a 50-something voter but this is unlikely to be true in the average Democratic house district.

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mathew's avatar

I think there's a good number of the Trump voters that didn't vote for him because they liked him, but voted because they were scared of the Democrat agenda.

In 2016 I voted for Gary Johnson, because I couldn't stand Trump. In 2020, I held my nose and voted for Trump because of the huge leftward slide on the Dems side

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John Murray's avatar

Yeah, I do wonder if Matt is not being a bit optimistic that the problem is that Democrats forget who the median voter is. It may be more likely they know who the median voter is, but for reasons of ideological preference choose to ignore it.

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Rory Hester's avatar

Seriously Matt. Just call me.out by name.

I am that 51-year old white middle class non-college educated suburban voter?

What do you guys want to kmow?

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Rory Hester's avatar

Also. I totality want to know about this anger management thing. But looking at some of Matts tweets, I can see it. I bet Matt can fight when pissed off.

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James's avatar

In my head, Matt needed CBT because he was relentlessly bullied by the cool kids in the Vox lunchroom for takes like today’s post. Probably far from the reality but it’s how I imagine things went down.

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Randall's avatar

I think that Matt owes us just one piece that’s written while he’s genuinely pissed off. Don’t stop and think, just type. He writes a piece every day, we can’t get just one written while his blood is up?? I hope it’s about housing.

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evan bear's avatar

I've seen Matt in person and he's bigger than you might expect. You'd be dealing with an angry big guy, not an angry small one.

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Rory Hester's avatar

I really want to get Matt in the gym lifting weights. He probably has good genetics.

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Nate's avatar

What’s your favorite diner

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Rory Hester's avatar

It was Rockies Diner in Boise. But they closed.

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Allan's avatar

what is your most normie political opinion, and what is your most idiosyncratic political opinion?

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Rory Hester's avatar

Cash payments agre good.

Police are good.

32 hours should be considered full-time. Anything over requires time and a half pay.

DC shoild be shrunk down to the capital and the white house. Everything else should be given back to Maryland or Virginia.

All Federal Agencies should be spread out across the country.

IRS employees should be banned from ever working in the private sector. And should be on commission when dealing with Rich people and Corporations.

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David Rye's avatar

I'll add for Rory here too since we're pretty aligned ... his most normie opinion is "we should tax the fuck out of the rich." His definition of rich is quite normie too - anyone making more.

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Rory Hester's avatar

This is true. Im touched you remember.

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Marc Robbins's avatar

Best places to eat in Boise, obviously.

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Rory Hester's avatar

Bad Boy Burgers.

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Chad peterson's avatar

$15 minimum wage?

Tax increases on $400k+?

Okay with leaving afghan?

Refundable CTC?

Infrastructure?

Stuff that’s not infrastructure that we call infrastructure?

Increase social security monthly check amount?

Lower Medicare eligibility age?

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John E's avatar

Why 400k? I don't understand how that went from 250k under Obama to 400k under Biden. Both of those are way, way above the median and put you squarely in the very top 10% of wage earners. I'm not saying that taxes on the someone making 250k have to be the same as someone making 5 million, but why would we want to lower them?

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Kenny Easwaran's avatar

My guess is that it's easy to find sympathetic-looking people at the $200k or $300k mark - for urban voters, it's the upper middle class family that just can't manage with daycare, decent housing, and a few vacations; for rural voters it's the farmer who is constantly worrying about going under; and for small town voters it's the main street business owner that can't find good and affordable labor. These images hold outsize sway.

I wish they didn't respond by promising that absolutely none of these people will see a single dollar of extra taxes - at most, they should promise that these people will see benefits that are at least equal to the amount of extra taxes they will pay.

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Charles Ryder's avatar

>>>I don't understand how that went from 250k under Obama to 400k under Biden>>>

You seriously don't understand this? I don't think it's complicated at all: many upper middle class people earn a lot more in 2021 than they did twelve year ago. Similarly, houses in blue metros are a lot pricier, as is college tuition, day care, and plenty of other stuff.

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John E's avatar

I should have said that I understand, but it's a bit disengenous at best. You can't assert inflation has been low for the last decades and then say that costs have gone up so much that 400k is the new 250k. The real truth is your point that large numbers of the blue metros have seen their income rise dramatically, but don't want to pay additional taxes even though 400k still puts you well into the top 10% of income earners.

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Chad peterson's avatar

$200 to $500k stay the same, they aren’t reduced.

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John E's avatar

Right, but that means that Democrats are simply cementing Republican tax cuts for top earners and are only willing to raise taxes on the very, very highest levels. That top 1% has a lot of wealth, but not enough to fund the spending being proposed.

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Rory Hester's avatar

Yes. Yes. Yes. Yes. Yes. No. Yes. No opinion.

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Chad peterson's avatar

And Manchin negotiated just a bit past 50 year old white guy from suburbia. He got some non-infrastructure spending into the deal.

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Rory Hester's avatar

Haven't paid attention. Working in Argentina.

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evan bear's avatar

You should be the person to decide whether a hot dog is a sandwich.

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Rory Hester's avatar

It is not. Neither is a burger.

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David Rye's avatar

Rory -- That is not the hot take I was prepared to deal with today.

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Rory Hester's avatar

Get ready. My hottest take:

Tacos can only be made with corn tortillas. Otherwise its just a poorly wrapped burrito.

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David Rye's avatar

Ok ok. Again. Not ready for this but ... only soft shell? Or are both hard and soft acceptable?

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Rory Hester's avatar

Hard shell should be banned for badly done cultural appropriation. But... my kids love Spaghetti tacos. So I will.let it slide as long as not sold in restaurants. Only used at home.

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Ken in MIA's avatar

What new welfare program do you want the “progressives” to put you on?

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Rory Hester's avatar

By put on me, do you mean I pay for? Or I receive?

Pay for: child tax credit even more generous.

I receive: hmmmmm. I would.like to qualify for Unemployment Insurance. I dont because I get a military pension. However rich people do qualify if they lose jobs as long as no pension or income.

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Ken in MIA's avatar

I meant what free lunch do you want your rich Uncle Sam to provide? He has a sky-high credit line and can also tax the rich to pay for anything imaginable.

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Rory Hester's avatar

Anything? 6 weeks paid vacation for everyone. Like Europe.

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Ken in MIA's avatar

I don’t think the government provides vacation pay in Europe.

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Rory Hester's avatar

Well we should, and then shame them. Though my ex-wife is on the dole in the UK... long story, I've led an adventurous life, but the government did give her a stipend to go on Holiday. I would think the US could subsidize it somehow via tax credits or something. At the very least, make paid vacation a requirement.

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Rory Hester's avatar

I Already have free Healthcare. So.... more generous social security.

Or more child tax credits

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Lost Future's avatar

My structural take is that American political parties are super-weak (the weakest of any party in the developed world!), and activist groups are really strong, and there's a societal tradeoff between how strong your parties are and how strong your activist groups are. And the activists- many of them single-issue groups- frequently can't think about or just don't care about what will ultimately help Democrats win elections more. They're frequently fanatics- they're frequently foaming at the mouth. Everything is black & white, good & evil with them. So they can't parse Matt's advice here, even if (ironically) it would actually help their causes in the long run.

I think we should have weaker activists & stronger parties. Which to varying degrees would mean rolling back Citizen's United (so that they stop funding candidates outside of the party structure), giving the parties more money to distribute to candidates *if they're good*, and making the primaries more controlled by the party so that any random yahoo can't run & win. But all of the activist groups will fight this- and worse, we're in the middle of a big populist supercycle, so 'making the Democratic (or Republican) party stronger' is uh not exactly a popular idea. Putting our primaries more under the control of the parties *like every other democracy on planet Earth* is not going to go over real well. So I throw up my hands and accept failure, for now anyways

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Andy's avatar

This is a really important point. Additionally, strong parties make it a lot easier to get inter-party factions to play nice which would be really helpful if your party needs every vote in Congress to pass legislation.

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Lost Future's avatar

Yeah. I mean, to make it realistic/specific for the American system, I doubt that the parties could just eject a backbencher..... but they could control the funds needed for campaigning & re-elections. And they could simply back a primary challenger with those funds while withholding them from the incumbent, if they don't play ball. I'm looking at all the 'moderate' drug pricing negotiation holdouts here

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Andy's avatar

We have examples from history - the Democratic party dominated Congress for many decades because it had a strong central party system that was able to manage a very diverse set of coalitions and factions. Today's parties have none of that, they are more like brands.

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Lost Future's avatar

Why? Multiparty presidential systems don't work. They've been tried in Latin America for 70+ years, this is like the consensus view of political scientists. They're a fractious mess, and it'd be even worse in the US because:

Our midterms elections & the staggered Senate schedule mean that the President would virtually never have their party in power. How effective would you say divided government is in the US now? You want to make it permanent?

And, the new parties that would form in the US would be explicitly ideological. The people that broke off from the Republican or Democratic parties would be the real nutsos. 'Parties' in other countries can be regional, but in the US it'd just be the true believers.

Imagine we need the swing votes of the America First party, headed by Marjorie Taylor Greene, to raise the debt ceiling. 'Sure, we can pass that..... after we deport every illegal immigrant in America!' Or say you need the swing votes of the AOC-lead Justice Dems to pass the annual defense bill- the one thing modern Congress doesn't screw up. 'Sure, we can pass that..... after we nationalize every oil company in America!'

If you multiple parties, go full parliamentary & PR. Can't do with a separately elected President

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Lost Future's avatar

Wait, how do modern American political parties 'strictly enforce voting discipline', what is going on :) The headlines for the last month are all, Biden desperately trying to get various Democrats to vote for his bills, and various Democrats refusing to. Trump couldn't get Obamacare or Section 230 repealed, etc.

If we had strict voting discipline, Manchin/Sinema would be voting for Biden's bills- because they're not, we don't. If we had strict voting discipline, various House 'moderates' wouldn't be refusing to sign on to prescription drug negotiation, or parts of the infrastructure bill, or funding the IRS, or getting rid of the stepped-up basis, or..... I mean it goes on and on. The fact that they're openly defying the party leader is what makes the parties not disciplined man :) That's the definition.

'Multiple parties creates issues where cross-pressured lawmakers can break with their typical coalition, and can be bargained with individually'

My assertion is- the new parties that form would be more politically extreme, so no, you're not going to get Marjorie Taylor Green or another MTG acolyte to break from the America First party. Or, get Ilhan Omar or her clone to break from the Green Party- no. They would probably get voted out of office for compromising!

I am interested by your Electoral College idea below, but that's basically parliamentarism- which is great! :) But it's essentially a parliamentary system, might as well do PR too at that point. I will grudgingly say it's *possible* that a multiparty US could work, but probably by a Germany-style 'the center left and center right parties always compromise to get stuff done, and the extremists always get ignored' type of government. So- maybe!

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Andy's avatar

I would like that as well, but the structure of our system strongly favors only two non-fringe parties. Even if we nuke both parties tomorrow, two more would rise up and take their place and we’d be back to the binary.

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DJ's avatar

I think you'd have to eliminate winner-take-all electoral votes too, something Madison came to endorse later in life.

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Andy's avatar

Sure, but takes rewriting State constitutions as well as the US Constitution to bring that about. IOW, it's never going to happen.

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Lost Future's avatar

When do you think that Maine amended their constitution? They didn't. If you're thinking of ranked choice voting- it was struck down by the courts for violating the state constitution, so they can only use RCV for federal elections

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Andy's avatar

It's certainly much easier for state-level positions. I don't see how it happens for Congress at the Federal level though. And then there is the Senate.

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Robsy's avatar

Great post. This is the problem in Texas- Dem candidates running for local and state positions must now answer for extreme left rhetoric propagated by activists thousands of miles away. It’s an easy layup for the GOP and local Dems got trounced in 2020. If you want Beto to win next year, the extreme Dem activists need to tone down the anti-capitalist, anti-police, etc rhetoric and offer something approaching a positive view of our country. Texas can definitely turn blue—but it won’t be the same blue as Portland and that’s ok! It would be a win! Yet when you mention that, the conversation you are having with your own political side (!) just morphs into a brow beating about how backward Texas is and blah blah. It’s purity or nothing.

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Andy's avatar

This is what happened in my state of Colorado. Democratic politicians here are, for the most part, far different from their peers in NY or CA.

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lindamc's avatar

Same in Michigan…

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DJ's avatar

I think Beto is doomed. Republicans are going to run nonstop ads of him saying "I'm coming for your guns."

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Sobopla's avatar

This is an interesting perspective. Who do you think would have a more realistic shot in Texas, Beto or the Actor? I think the latter might be fun to see, Beto has already made a career out of running and losing

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Miles's avatar

well in terms of Texas I think Presidential Candidate Beto ruined the reputation of Senate Candidate Beto... A good example of the difference of chasing the national Dem primary audience versus the Texas general election audience...

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David Rye's avatar

Similar thing happened with Bullock in Montana. If he doesn't launch that 2020 presidential campaign I think that senate race is way more competitive.

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BD Anders's avatar

I am a Montanan and endorse this viewpoint.

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Sobopla's avatar

I was actually referring to the serious rumors of Matthew Mcconaughey running for office, but I agree Beto is a pretty good actor too

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Robsy's avatar

At this point I can make a case for either one depending on whether you want to turn out the Dem base/registering new voters or if you want to try and also appeal to moderate Rs. David Shor has data saying that it’s easier to peel off Rs than it is to get non voters to vote, so there’s that.

McConaughey is leading Abbott by 12 solid points in the latest polls- that’s huge (Beto 5 behind). He would lasso a heaping ton of free media coverage, is great with sound bites, is seen as Mr. Texas with his confident devil may care swagger, and would create excitement in a huge state that’s difficult to fully traverse. He’d be better able to navigate rough waters when Abbott makes everything about red meat social issues. He’d get fire from both sides however, as the GOP would try (and fail bc he’s too likable and authentic and Texans prize Authentic) to paint him as a Hollywood liberal and the Dem base would paint him as too conservative (he supports the UT Band retaining The Eyes of Texas as their fight song for example- tiny potatoes nationally but a big cultural signifier in TX.) I think he could win if he surrounds himself with a good team. It’s unfortunate that media and celebrity play such a big part in today’s elections but it’s the chess pieces we are given so we gotta play. He also might be ahead because he hasn’t exactly staked out a bunch of policy positions.

Beto is a base favorite as he’s a policy nerd, smart, and was heads and tails above past Dem candidates. He got the gun policy hung around his neck but his policy is less extreme than Biden/Harris and they gathered more votes in TX than Beto. He came very close to winning against a very hated Cruz (I block walked for Beto and he is hated by most GOP as he’s seen as a total fake, which he is) during an off election year. Abbott has plummeted in popularity due to the horrible way he handled the freeze and grid issues, the abominable vigilante- justice abortion bill, and taking local

control away with Covid mitigation. **But Beto underperformed with Latinos vs Hillary especially at the border. Beto is popular with urban and suburban progressive whites but that’s about it. Latinos swung toward Trump in the last election (McAllen is 90% Latino and recently elected a GOP mayor) and it’s embarrassing so many white liberals don’t take Latino patriotism, and more conservative views on immigration/law enforcement into consideration. It’s super smug.

**GOP and some moderate voters will swing to Abbott if the conversation goes to extreme social issues and anti-American sentiment, guaranteed.

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Charles Ryder's avatar

What do you mean by "Beto is a total fake?" I don't follow TX politics very closely...

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Robsy's avatar

Cruz is a fake- not Beto…sorry if I typed that too fast- typing a my thumbs while walking!

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Lance Hunter's avatar

I think the median Texas Democrat is fairly close to the median US Democrat. (And honestly, I wouldn't be surprised if Beto literal is the median Texas Democrat.) The problem is that the median Texas Swing Voter is generally a fair bit to the right of the median US Swing Voter.

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John Crespi's avatar

It isn’t just legislation where Dems are missing the median voter. To me it’s fascinating watching this French sub thing. I had a great conversation with a median voter yesterday who pointed out how Trump would be taking victory laps on this and how he felt like waving the flag too, but the skew of CNN and NYT is that we hurt an ally. Doesn’t matter if you think that way, the median voter wants to flag wave and this deal shows a toughness against China and a win for US interests. Trump would be hollering it but liberal editorials are worrying over things the median voter doesn’t agree with. The median voter will back Biden but does think he’s weak on defense. Maybe it isn’t Joe’s style to gloat but that photo of Macron poking his finger in Joe’s face was splashed all over right wing sites for weeks. The lede this weekend should have been that photo with a caption like Don’t Poke Joe. Don’t let opportunities go to waste.

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Robsy's avatar

You are so on point with this. The incessant Everything About America Is Bad! narrative is starting to destroy Dem chances with normal voters in swing states. I hope we can craft a more positive message about our country.

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John Crespi's avatar

If Liz Cheney really did start a 3rd party, it would hurt Dems as much as Pubs. There a lot of voters in the middle who are so turned off by the extremes.

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Nick P's avatar

Liz Cheney is in no way a centrist.

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John Crespi's avatar

This is sort of MY's point. You and I don't think she is, but ask a median voter if he sees her that way? I assure you, he does.

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lindamc's avatar

Yes to all of this. I worked in Dem policy circles in the 90s and can validate what Matt says--normies did not obsess over what Washington was doing, let alone esoterica such as reconciliation or cloture. But nobody had to say that, it was totally obvious, as was the fact that people who wanted serious movement on progressive issues should keep quiet during elections so that progressive candidates could talk to median voters and win.

I used to think that, based on many years of working in DC, I knew a lot about politics. In the mid-2010s, I watched what was going on and realized I didn't know anything about politics. Now, having spent most of the pandemic around the Grand Rapids MSA, I feel like I could set up a consultancy to school people currently involved in politics about the median voter.

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Dave's avatar

I think part of the problem is that lots of people in Dem politics start young and come up through organizing. That's great experience but it creates a bubble b/c all your friends have also been in Dem politics their whole lives. We would benefit a lot from getting people to come into Dem politics from other industries and thru different paths

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Matthew S.'s avatar

Back in 2012, I worked as a volunteer on a fairly progressive primary campaign for the House in a fairly moderate swing district. Moderate enough that the seat switched hands between the two parties in several consecutive elections during this period. The early twenty-somethings I worked with who had parachuted in from other places were very nice, and smart, and had a good grasp of policy, but were definitely not representative of the views of the electorate where I lived and they were working.

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lindamc's avatar

Agree but I would take it further--it would be better if more diverse (in every sense, including education, work experience, point of view, etc) people were involved in electoral politics and actual governing.

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Matthew S.'s avatar

I totally agree. I'm not even like, super anti-elite or anything, either. I'm mostly fine with the majority of lawmakers being people who, you know, went to law school. I'm fine with a large number of the people who do the jobs of journalists, campaign workers, etc., to be people who studied that stuff, but I think it's good for the health of the society to make sure that we have a strong infusion of people from different backgrounds into areas that can be very cloistered.

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DJ's avatar

Part of it is the collapse of local media. I lived in Chicago in the nineties and read the Chicago Tribune every day. They were the "Republican" paper, but mainly only in their editorials. The editorial page itself was very diverse and of course the daily news covered local issues instead of just disasters and DC politics.

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lindamc's avatar

Could not agree more! In the Detroit area when I was growing up, we had the more liberal Free Press and the more conservative News. Like many/most of the families around us, we got both.

The nationalization of politics and news generally has not, IMO, been good...as I've previously noted here, for most "issue" coverage I now read substacks instead of NYT, WaPo, etc. But I can't talk about them in any detail with anyone I actually know and talk to in person, because literally none of them read the same stuff.

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atomiccafe612's avatar

I think this problem is taken to its extreme in local politics in progressive jurisdictions. In these places the left doesn't even seem to care to try to win elections at all. Portland is the city I'm most familiar with, it has an extremely milquetoast establishment mayor. Progressive groups tried to beat him but lost in 2020 (fine) but instead of reevaluating how to get above 50%, they simply turned around and started a recall. It is also commonplace for many on the left to basically blame voters for being insufficiently progressive.

https://twitter.com/ZakirSpeaks/status/1439667941159604225

The result is you end up with a mayor/city government that is way to the right of what people would tolerate if progressive forces were aligned and fielding solid candidates. The constant protests and vociferous objections from the left don't succeed in winning power but they do succeed in making the city government unpopular and make it so nobody who has higher ambitions runs for city office.

I feel like city politics in most progressive cities would be a lot healthier if you had some local progressive parties that fielded candidate slates to challenge the establishment... for all their flaws NY and SF progressives do manage to give the voters in those cities a real choice in every election.

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CRS's avatar

Absolutely 100% on everything until the last paragraph.

On the prescription drug plan, this is a very specific proposal that may well have some serious problems. Where did this proposal come from? Has it been discussed or studied? There are legitimate concerns about incentives for drug development.

Yet,.. when a member says "wait, is this really a good idea?" they are smeared. But it's a good question. I want drug prices to come down too...very much so. But it's tricky. I don't have confidence that this is the way to do it, and there could be real harm done over time. But we are in "Pharma bad" mode, instead of figuring out how to make pharma work for us, rather than the reverse. I want cheaper meds but lots of innovation as well.

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David R.'s avatar

Letting Medicare haggle for prices, with the presumption that pharma should be able to profitably supply it with a medication for the same price that it profitably supplies the UK, German non-profit insurers, or Canadian Medicare… is the dictionary definition of good, sensible, flexible policy.

They still get to make their case and haggle, but let’s face it… their advertising and lobbying expenditures are, conservatively, 50% higher than their R&D expenditures. There’s plenty of fat to cut before innovation dries up.

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dysphemistic treadmill's avatar

I generally agree with the message of today's post.

But I want to flag one particular way of mis-hearing it that I think leads to familiar errors.

MY says, "pay attention to the median voter -- they're not like typical journalists and Dem activists."

Journalists and Dem activists: "It's time to dust off our pith-helmets and go on a Cletus Safari! Let's go talk to the most retrograde mouth-breathing Ditto-Head Magats, and pretend to understand and appease them!"

We need to distinguish between Reachable Median and Unreachable Cletus. And not waste any time on Cletus. Doing so is not only futile, it is also condescending and alienating to Reachable Median.

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Erik's avatar

“Who are we centering here?" is the key question. I think that with current Democratic staffers, even if they are clear on who the median vote is, if framed this way, will choose to center someone else.

That runs through both wings of the party. Your more centrist Obama/Hillary staffers will choose to center women and minorities. Your more progressive Bernie/Ayanna Pressley staffers will choose to center on the economically disadvantaged.

In either case, to choose to center on the traditionally empowered over the oppressed is an original sin. Moral righteousness dictates that you do not do so, even if that means you lose!

And that drives me up a wall.

On the other hand, history has shown us that Democrats who have a "just win" mentality are dangerous, even if they are marginally better than Republicans. Bill Clinton's 8 years comes with a laundry list of decisions that at worst are foundational to the problems of 2021 or at best kicked the can so hard that it's only now coming out of orbit. Financial deregulation, the crime bill, Internet governance, you name it and Bill Clinton took the easy way out from a political perspective over doing the smart thing that might be difficult. He won, but what's the point of winning?

So where does that leave us? With a GOP that must be held out of power, with a progressive wing that can't get over themselves enough to actually win, and with a middling centrist faction that can't properly use power for fear of losing it.

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JA's avatar

Part of the weirdness of this strategy is that a lot of times, these staffers use definitions of "disadvantage" under which they themselves are disadvantaged, but the median voter isn't. But political activists who went to Swarthmore and Oberlin are in a lot of ways way better off than the median voter, so this comes across as ridiculously out of touch.

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evan bear's avatar

Reminiscent of that article about the incident at Smith College, where the student got the administration to force all the working-class cleaning people to go through diversity training.

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Matthew S.'s avatar

I saw glimpses of this even *within* the ranks of very liberal political operatives on a campaign I worked on. I heard grumblings from some campaign staff that the candidate was out of tough because he went to [very liberal Canadian college X] and not [ever-so-slightly-less, but still very liberal, American college Y]. The candidate came from a background of having money, and the operative did not. Class cuts deep, even amongst the privileged few.

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Paul's avatar

Instead of using power, why not just focus on incrementalism and good government. If we can slowly, modestly and consistently improve laws and structures, the net effect will be large.

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lindamc's avatar

Reminds me of a thing I heard Will Wilkinson say on a podcast: “What do we want? Incrementalism! When do we want it? In due course!”

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Sharty's avatar

It seems worth noting that most voters don't even know what "centering" is meant to mean in this context. I'm only dimly aware, and I'm a young urbanite with advanced degrees.

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John Crespi's avatar

I dunno, I don't disagree with you, and am not a big fan of Bill, but we don't realize today just how hard it was to get a lot of this stuff enacted:

https://clintonwhitehouse5.archives.gov/WH/Accomplishments/eightyears-02.html.

Dems today might not go along with it, but to MY's point, Dems back then were able to run on many of these ideas and you can't change policy if you aren't under the capitol dome.

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Ted McD's avatar

Agreed. "Why are these folks performing centrism instead of using power to achieve moderate goals?" has been a background complaint in my head since Obama was elected. I have yet to see anyone explain this phenomena. I find it extremely frustrating.

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Ted McD's avatar

But "do popular things, regardless of whether my party endorses it" would seem to achieve much the same end. Yet that does not seem to motivate them.

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BD Anders's avatar

I agree with the main thrust, with a caveat: its not 1992 anymore. By which I mean, it seems like a lot of people who focus their gaze out of the liberal urban coasts are also still assuming that today's 50 year olds are responsive to baby boomer cultural markers, as they were in 1992. Today's 50 year old was born in 1971, and grew up with punk, hair metal, hip hop, and graduated college as the Cold War ended. Elon Musk, Kid Rock, Amy Poehler and Regina King were all born in 1971. Tupac was born in 1971; Kurt Cobain was born in '67! The "old stand-bys" of moderation - non-critical patriotism, deference to age and class, "I smoked, but I didn't inhale" - no longer apply. At all. The median voter, at 50, is still young enough to want to be cool. A Reaganesque, white-picket patina over working class economic issues git the job done in 1992, because thats what a 50 year old wanted then. They don't want anything quite so airbrushed now. They won't be scared off by blunt talk about drugs, sex, and race, which seems to be what many elected "moderates" believe.

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MJS's avatar

Yeah, but 50 is just the median, so we also need to consider a sizable portion of the age range past 50 as well in all of this.

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BD Anders's avatar

True. Also, Gen X, as a cohort, is smaller than either the Boomers or the Millennials, so the median voter is in a "valley" between two larger demographics. Maybe we should be more concerned with the "mode" voter?

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myrna loy's lazy twin's avatar

Yep and legalizing weed is pretty popular with people that age. And a lot of republicans are still against it. I sometimes wonder if the Democrats putting legalize weed in their platform and making a big deal about it would improve their election prospects

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Marc Robbins's avatar

Being a member of the Boomer generation (you know, Vietnam and all that), I just learned that our markers were non-critical patriotism and deference to age and class.

Good to know.

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MJS's avatar

IDK, for every boomer marching against the war there were probably two boomers happily enlisting. The people who write books and make movies about that generation like to focus on the hippies and protesters but outside of the city centers there were plenty of "Okies from Muskogee" as well as people who got into hippie circles for the "grass and ass" only to grow up to trade stocks and vote for Ronald Reagan. The people doing those pop-culture depictions of the 60s probably could have used their own "the median boomer actually thought..." reminders.

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Marc Robbins's avatar

Well, I grew up in the South in the 60s and every single guy I knew was trying every damn trick in the book to get out of being drafted or at least not being sent to Vietnam.

I didn't know of anyone who "happily enlisted" but yeah there was a lot of drug use so people did do some crazy things.

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MJS's avatar

Only about 25% of the troops in Vietnam were official draftees. Granted, some of the "volunteers" only enlisted in order to gain some choice of branch and specialty, still, the number of volunteers was substantial. Also note that 50% of boomers are women, so draft anxiety was not foundational to their coming of age.

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yellojkt's avatar

I started Cognitive Behavior Therapy a few months ago to deal with grief and depression. So much of it is obvious platitudes which feel very Stuart Smiley-ish but the whole paradox of common sense is that it isn't very.

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Allan Thoen's avatar

Agree with this. But on drug pricing - that may be the most popular thing, but the Democratic proposal was seriously misguided and Sinema and others were right to kill it. What people care about is their out of pocket costs for drugs, same as with hospital or physician fees, which is addressed by regulating a different industry - the health insurance industry, not the pharmaceutical industry.

What Democrats were proposing wasn't govt "negotiation" of drug prices, it was national price controls on drugs, based on drug prices from other countries that have comprehensive price controls not only on drugs but also on physician compensation and hospital fees.

Physicians are skilled labor and deserve fair compensation, but at the end of the day they are laborers in healthcare, not innovators, except when they get a good idea and start a biotech or medtech company to commercialize it. The innovation and advances in healthcare are mostly on the pharma and medical device side, not the hospital or physician side. So it does not make sense to impose price controls on the innovative technology side and allow costs to balloon uncontrolled on the noninnovative provider side.

Come back to talk about drug price controls when Democrats have a plan to reduce physician salaries and hospital fees, or regulate the drug benefits of health insurance plans to ensure that patients don't get unfairly saddled with out of pocket costs for drug treatments but not for hospital or physician treatment.

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Tired PhD student's avatar

I think that your view on innovation is really wrong, but it also directly benefits me (I'm from Europe), so I don't know that I have a strong incentive to disagree. :P

Anyway, here's what I think happens. In Europe, there are aggressive price controls on drugs, so we essentially pay for production cost plus profit. In the US, aggressive price controls don't exist, so Americans pay for production cost plus profit PLUS R&D. Therefore, the same drug costs much more in the US than in Europe (whether Americans pay for it out of pocket or through insurance premiums). I won't complain that you guys want to subsidize Germany and France. After all, both countries are poorer than the US. But let's not pretend that it has anything to do with innovation. It is simply a way to not move some of the R&D cost on Europeans.

PS: I wholeheartedly agree that price controls on physicians and hospitals are needed, by the way.

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Allan Thoen's avatar

Yes the Europeans and others do free ride, but the most important thing is that WE benefit from the advances in medical care that comes from the R&D we pay for. Slashing the money available for important R&D to spite the spite the Europeans for free riding is kind of cutting off our nose to spite our face. We maybe could do a better job ensuring that more of the R&D we pay for happens here though - European pharma companies make a disproportionate share of their revenue from the US market.

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Tired PhD student's avatar

I'm not convinced that such a change in the US will affect R&D at all. The EU isn't that poor that would sacrifice medical innovations to keep drug prices at their current level. We have wonderful American inventions in the EU like the latest iPhones and the latest Teslas too! I would be more convinced about your thesis if that pack of eye drops I have seen both in the EU and the US didn't cost something like literally 8x here (although insurance actually roughly equalized the out of pocket prices, which explains why my American monthly premium is so much higher than what my European premium used to be).

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GoodGovernanceMatters's avatar

I think this topic is certainly complex and I don't want to make too strong of a claim on what price controls will do, but I will say that it's hard to see the counterfactual and easily notice the absence of innovation and that we do have examples of areas where lack of profit opportunity reduces innovation: e.g. vaccines. The iPhone and Tesla don't really work as examples because there are no price controls of those.

If we really wanted to do price controls on drugs we probably should come up with some scheme to directly push innovation (which can be complicated but I hear Bernie had some proposal around prizes?) and reduce the cost of complying with regulation (e.g. somehow streamline the FDA processes or only make the company pay for part of it depending on whether the drug has likely public health benefits). If all we do is squeeze profit opportunities out of the system we're likely to end up with a lot less innovation globally in an area where we really need it.

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Tired PhD student's avatar

I'm not attacking the profit motive (which I actually think is good and essential). I'm attacking the huge US-EU price discrepancies for a given product that can't be explained by the general discrepancy between US-EU incomes.

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GoodGovernanceMatters's avatar

My bad, I may be misunderstanding your argument. My rough version of the US subsidizing global drug R&D argument goes like this (I'm not sure if it's really accurate and this is the exaggerated version): Per your equations above currently the US implicitly pays for most of the R&D spending. If they cap it then either R&D spending goes down or someone else makes up the difference.

I don't see the EU reacting to the US passing price control by offering to pay more for drugs all of a sudden or really changing anything. So to keep the same amount of R&D spending (or increase or improve it) something else would have to happen in addition to simply passing price controls.

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John E's avatar

What if we solved that by saying that no drug could be sold in the US if it is sold for less elsewhere in the world adjusted for GPD per capita? So a drug in the US that sell for $100, could be sold in India for $3 or more, while in Germany it could sold for $71 or more.

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Andy's avatar

I think that is true - Matt essentially made that argument on the weeds recently that our high prices are de facto subsidizing Europe and others. If true, then fixing our own prices based on what Europeans pay probably isn’t going to work unless one assumes those R&D costs will force prices increases outside the US.

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RS's avatar

The R&D concern is meaningful, but heavily overstated. Pharma companies make a lot of money for their shareholders. That net revenue could be substantially reduced without impacting R&D expenditures.

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Andy's avatar

In theory yes, but I don't believe that central planners engaged in price-fixing know where to draw that line.

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Tired PhD student's avatar

Oh, you don't need to fix the price! You just say "If you sell this in Germany too, I'm not willing to pay more than 30% above the German price.". The target can be comparative, based on proof that a company can actually invent and sell the same thing to some other rich nation at a lower price.

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Andy's avatar

Using a formula doesn't make it not price fixing.

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Ken in MIA's avatar

If you think pharma firms are too profitable, attack their rent-seeking behaviors and barriers to entry. That is to say that to the extent there is a problem with drug prices it is a government failure.

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Tired PhD student's avatar

Well, I think Europe will have two options in that case. Either forgo some drugs, or increase prices. I know that Europe is poorer than the US, but I don't think that it's that poor that you can't have American prices rise a little bit before we start declining to buy new drugs. For this reason, I think changes must be made incrementally until the point where you start hurting innovation (as opposed to just subsidizing the EU) is found.

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GoodGovernanceMatters's avatar

The issue is not existing drugs but future ones though. The existing drugs subsidize research into new ones, including all the ones that never pan out.

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Lost Future's avatar

No, the government setting a maximum on what it will pay is not a 'price control', you're using that term incorrectly. Let's pretend that Miraclepharma just invented Miracledrug.

Price control scenario: 'We, the government, forbid you from charging more than $1000 for Miracledrug, to anyone, anywhere'

Price negotiation: 'We, the government, will only pay you $1000 for Miracledrug, but if you and a private insurer or other private party want to pay more than $1000- that's totally cool. Insurer wants to pay $1500 or 2000? Sounds great, go wild guys'.

See the difference?

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Allan Thoen's avatar

Yeah but the scenario created by the Democratic proposal is the first one, the price control scenario, not the second one. Read the bill, and you'll see.

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James C.'s avatar

Matt made an interesting point on his final Weeds episode that there could be innovation in healthcare delivery too with regulatory relaxation, e.g., more telemedicine.

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Allan Thoen's avatar

For sure - that's very important too but a kind of innovation than the I was talking about, more about improving efficiency and making sure the total amount of money we spend on healthcare is allocated intelligently and put to the highest value uses. More telemedicine reduced scope practitioners, abolishing corporate practice of medicine rules, better care management, vertical integration and such.

The innovation I was talking about was more technological - i.e., if you took our doctors and plopped them into the 1920s they'd still be just as caring and dedicated to their patients, but get much worse results without modern pharmaceuticals and medtech.

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