Commentary on Policy and Politics–which includes pretty much everything
Mike Koetting’s career has been in health care policy and administration. But it has always been on the fringes of politics. His first job out of graduate school was conducting an evaluation of the Illinois Medicaid program for the Illinois Legislative Budget Office. In the following 40 years, he has been a health care provider, a researcher, a teacher, a regulator, a consultant and a payor. The biggest part of his career was 24 years as Vice President of Planning for the University of Chicago Medical Center. He retired from there in 2008, but in 2010 was asked to implement the ACA Medicaid expansion in Illinois, which kept him busy for another 5 years.
Polls have been showing about 50% of the country approves of President’s Trump handling of the coronavirus pandemic. I was at first perplexed by how this could be in the face of what seems to me like egregiously poor performance. Then I decided I was confused by the wrong thing.
For the purposes of this post, I want to focus only on the non-substantive parts of his performance. Initial returns suggest that the administration made many substantive mistakes. But I want to set this aside for the moment. Plenty of people are writing on the specifics and the final evaluation will get hashed out over time. Even so, it is worth keeping in mind that, as much as we like to pretend we are non-biased, no one is immune. For instance, the Washington Post notes that the constantly quoted charge that Trump disbanded the office of global health affairs is substantively more complicated. More time will give us a better view.
Coronavirus is a monster hit to every aspect of our lives. It is hard to imagine writing about anything else right now and every publication is full of articles on the topic. But most of them are providing advice (not always consistent), looking at its short term impacts, or, here and there, guessing about long term impacts. I have nothing to add to those. At least at this time.
What I do want to write about is lessons that might be learned for dealing with another issue of even potentially larger impact–climate change. As disruptive as coronavirus undoubtedly is, my guess is that the changes that could be wrought by unchecked climate change will be even bigger, and last longer. Maybe we should consider the virus as a practice run and take advantage of what seems like a teachable moment to get the people of this country thinking about what we can learn from the pandemic and what it might suggest we focus on going forward.
David Brooks’ recent column, “Why Sanders Will Probably Win the Nomination,” at this point seems to have been seriously premature. But what he got right and wrong is worth revisiting.
The gist of his column was that Sanders would probably win the nomination because he had a story—Brooks call it a “myth”—that is simple, easy to get your head around, and coherent in its own way. The other candidates didn’t. (Actually, Brooks thought Warren did too, but he believes it was just a different version of Bernie’s.) Brooks see the Sanders’ myth as having the same “us versus them” structure as the myths told by Donald Trump, just with different villains. Brooks argues that not only are both myths wrong, but their “us-versus-them” narratives are obstacles to the “great yearning for solidarity, and eagerness to come together and make practical change” that are the real underlying wish of ordinary people.
This month my book club read The Border, by Don Winslow. It’s a novel, basically a thriller, focusing on the drug trade between Mexico and the United States. Though fiction, it is enough rooted in the underlying facts of the drug trade that you cannot help but emerge with a new appreciation for the extent of the problem.
The are a couple of obvious themes. The War on Drugs has been a disaster on both sides of the border and it will never be solved as long as the possible profits are so staggeringly large. Moreover, there is some level of complicity in parts of the financial elite, either because they have drug money in their holdings, because they are creating conditions that make people susceptible to drugs, or both. One of the double-edged throw-away lines in the book is a character who asks “You know what’s the difference between a cartel leader and a hedge fund operator? Wharton Business School.” (The shot at President Trump is deliberate. He and Jared Kushner appear as very-thinly disguised villains in the book.)
This is by no means great literature and I am not suggesting you run out and get a copy. But I have found myself thinking more about the issues raised in this book than issues raised in better books. Two in particular I just haven’t been able to get out of my mind.
I didn’t have very high hopes for the Impeachment proceedings and they did not fail to disappoint. I won’t try to make sense of either what happened or my own reflections on it, which are varied and mixed. But here are some thoughts, maybe loosely connected, maybe largely random.
The main problem with globalization is that you can’t quit. No getting out of the club. Just isn’t possible. There are plenty of other problems with globalization. They are very difficult and some are at the very edge of human’s ability to solve. But the most important underlying feature is that it is here and, unless you believe you can jet off to another planet without taking earth’s problems with you, the only way to avoid it is to let things get so bad that we all have to start over. That does not sound like a fun ride.
Here’s why you can’t quit globalism. And there are more where these came from.
Just before Christmas, we saw Dark Waters, Todd Haynes’ movie about a lawyer whose career (and much of his firm’s) had centered on work for the chemical industry. The movie opens with him in a corporate board room joking with chemical company defendants about how to deal with the EPA over some SuperFund sites.
Only because of a haphazard connection—his grandmother was good friends with the neighbor of the farmer who shows up in the law firm’s reception area—does he even pay any attention to the fuzzy videos of dying cows the farmer brought. His immediate assumption was that the farmer didn’t really understand what was going on, an attitude that comes through loud and clear to the farmer. Before it’s over, the lawyer winds up taking on DuPont Chemical Company as it becomes unmistakably clear that DuPont had not only been maliciously careless in disposing of very toxic waste, but that it had deliberately and systematically been involved in a 15 year cover-up of the toxic impacts of one particular chemical, PFOA.
The movie, based on a very real case as reported by the New York Times, is a typical David v Goliath story, the lone hero against the corporate villain—although in this case, David is supported, even if occasionally reluctantly, by a well-resourced law firm. It’s a good movie and a stinging critique of what can happen when corporations run amok.
The Deep State has been getting pretty good press for the last several weeks. A passel of career foreign service officers has taken the opportunity to speak up on what they see as violations of the norms of governmental conduct. We also learned that at least two officials in OMB quit in protest over the Ukraine shenanigans. In general, the ongoing guerilla warfare in some agencies since Trump arrived reflect an ongoing commitment to the stated goals of their agencies, as opposed to Trump’s desire to roll back the clock.
Now may be a good time to take a deeper look at the Deep State.
The right wing idea of “The Deep State” posits some overt, coordinated effort by career employees to thwart Donald Trump and anyone else who would make radical change towards its version of reality, or, in the more paranoid version, to bring an end to American democracy. I agree there is a Deep State of career employees that has a momentum of its own. But there is no clandestine conspiracy here. What happens is that career employees who, exercising their own judgement and carrying out their job as defined over time by the history of legislation and the agency in which they serve, become a counterweight to the swings of presidential powers. This is not an active conspiracy, it is simply the friction that accrues from a massive bureaucracy which has, in part, recruited talented people who are motivated by ideas of social welfare and the goals of their agency and who are committed to the rule of law.
Today’s post is largely a rip-off of a 1992 essay that Alain Touraine wrote for UNESCO. In theory, I could simply refer you to the article. But, while ostensibly written in English, Touraine is French, which affects habits of mind as much as language. It took me multiple readings to translate his English into mine. Moreover, the essay is written in particular response to the collapse of the Communist state, and parts of it seem less relevant now. So I am offering today’s post as an easier way to think about some powerful issues.