Morning Ed: Healthcare {2018.01.11.Th}

[Hc1] Wow, this sounds great. Though I think a lot of people I am more interested in gum regeneration than teeth regeneration.

[Hc2] What if the problem with health care prices isn’t actually health care prices?

[Hc3] I’m sure this is the right decision, but eep.

[Hc4] One of the things about malpractice suits is that it often matters more where you practice what specialty than it does how good you are at your job. {Related}

[Hc5] Multitasking with anything is unwise, but surgery especially so.

[Hc6] Doctors often blame lawsuit potential and radiologists for unnecessary care, but neither should fly.

[Hc7] A look at how we might fix the hospital readmissions program, which hasn’t necessarily had the desired outcomes.

[Hc8] Pete Kolchinsky looks at the relationship between the US and its biopharmaceutical industry. Is Big Pharma upholding its end of the bargain?

[Hc9] Well, at least it’s not just smokers and fatties anymore.

[Hc0] A look at comparative history of health care, and why Canadians ended up with one system while we ended up with another.


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139 thoughts on “Morning Ed: Healthcare {2018.01.11.Th}

  1. Hc4: Gosh, there is so much wrong with that article that I am reminded why I don’t subscribe to the New York Times. We can begin with how, like so many bad articles about medical malpractice, it treats the subject as if the doctor had nothing to do with it. Malpractice lawsuits just sort of come out of the blue. The doctor can minimize the odds through careful selection of specialty and practice location, but beyond that it is like being struck my lightning. Then there is the classic Bad Journalism technique of writing a long article bemoaning malpractice lawsuits, with a couple of brief quotes from the other side so the whole thing is balanced. feh.

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    • Doctors have very good press because nearly every television show portrays them as noble people that only care for healing even if they have an irrasicisble personality. Lawyers tend to be depicted in a more mercenary manner unless they are prosecutors or work for NPO.

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    • “The doctor can minimize the odds through careful selection of specialty and practice location.”

      This seems to be what the article is saying, so I’m not sure what your disagreement with it is. A hospital in the poorest area of the Bronx has the highest rates of life-threatening complications during childbirth. Poor people are less likely to seek pre-natal care; more likely to have drug and alcohol abuse problems during pregnancy; more likely to be obese, etc. The more life-threatening complications, the more malpractice claims, and those costs end up getting born by the hospital and doctors, but unlike the hospital, the doctors can make a “careful selection of . . . practice location.” And then the hospital ends up with some doctors who “can’t get a job anywhere else.”

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      • My disagreement is with the ignoring of the possibility of the doctor actually screwing up. This is obliquely hinted at later in the article with the admission that there are a lot of crap doctors practicing in the Bronx, but the doctors who get the attention of the article are all good, noble, and true. So if they are sued, it can’t possibly be because they screwed up, and if the plaintiff wins the trial, that is just those wacky juries.

        You know how surgical teams nowadays are obsessive about counting everything that goes into the body cavity and counting everything that comes out? Do you think this practice evolved out of noble purposes trumping considerations of getting out of the operating room as quickly as possible? Or because of how juries react to pictures like this:
        https://cdn-03.independent.ie/migration_catalog/article25082813.ece/7dc24/AUTOCROP/h342/X-Ray_SXC

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        • IIRC, anesthesiologists got real tired of being sued in the 80s (due to the rather high rate of people dying) and underwent a lengthy, self-directed (via their professional organization) study, which changed a lot of things.

          The risks of general anesthesia have been greatly reduced (I mean it’s still not the safest thing you’re going to do, but it’s a lot safer than back in the 70s and 80s). Of course, your pre-surgery questionnaire is lengthy and there’s a lot of medications, vitamins, supplements, and other things they have to account for.

          *shrug*. Doctor’s aren’t perfect, and sometimes professional practices leave a hell of a lot to be desired. I recall one study that was just about implementing better sterilization procedures (handwashing, glove changes, etc) and seeing a massive drop in secondary infections being passed around in a hospital. And not one that was really out of line in terms of it’s secondary infection problem.

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          • Being someone who practices law in the healthcare world, generally on the provider side, it’s important to remember that they’re just people doing a job. It’s a very important and sensitive job, but they shouldn’t be treated as deities (or hucksters). Many do walk around with an air of confidence and infallibility, which I suspect comes from a mix of personality self-selection and the rigors of the training process.

            My opinion is that the malpractice issue has a lot less to do with how treatment is provided and a lot more to do with how we pay for healthcare/support permanently disabled people. It could be treated as a purely professional matter if those injured weren’t forced to rely on the tort system to cover their costs post accident.

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  2. Four crowns (two because of teeth that broke around a large old filling), apparently possessing the “bad British tooth genes” I am told are a thing….yeah, I would welcome Hc1. I’ve changed how I eat in order to avoid breaking the one remaining filled-but-not-crowned tooth (I know it will need a crown eventually)

    I also know a lot of people praise dental implant therapy but the whole idea of it squicks me out and I’ve also heard in some cases the results are not as hoped for. (And I think if you’re at risk for osteoporosis, it might not be the greatest idea)

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    • I think it’s a variant of “that ain’t gonna fly”.

      So Doctors are blaming lawsuit potential for unnecessary care? That ain’t gonna fly.
      Radiologists? That ain’t gonna fly either.

      Well… okay, they might get away with that narrative… But neither should be able to get away with it.

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    • Whenever you hear a doctor claiming he runs unnecessary tests because he is afraid of lawsuits, keep in mind that “standard of care” is a winning defense. The plaintiff has to find a doctor to testify that any competent doctor would of course run those tests under those circumstances. In the meantime the defendant can put up a colleague to testify that no, that that test wasn’t called for under the circumstances.

      Also keep in mind that the plaintiff needs to prove that the test would have made a difference. In other words, that doctor is simultaneously claiming that this test was unnecessary, but it totally would have made the difference in the patient’s treatment. Huh?

      Finally, keep in mind that many providers are paid on a fee-for-service basis. In other words, that doctor ordering the unnecessary test is paid to order it, then he is paid again to stroke his chin and ponder the results.

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      • I considered filing some sort of malpractice suit against a dentist after a cavity fill went wrong. This was in part inspired by another dentist reacting in horror when he looked at the xrays. I was, like, 24 and figured that would be enough to get my money back and help paying for the necessary follow up. When I approached the second dentist about a possible suit, he quickly backtracked.

        Basically, he thought the first dentist did a bad job and made the sort of error that dentists generally shouldn’t make while also acknowledging that even taking all the right steps can lead to the sort of errors she’d make and that he wouldn’t/couldn’t go on record in court saying she committed malpractice. It was an interesting lesson to learn.

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        • This touches on my broader views on the subject.

          Lawyers often state that truly frivolous lawsuits are super duper rare. Those that make it to trial have almost universally met some degree of credibility. Let’s assume it’s true.

          They also say that really we should have many more lawsuits than we do, because many legitimate cases of malpractice are never pursued. Let’s also assume this is true.

          I don’t know if the first one is true or not, but I totally believe the second one. I’ve heard figures ranging from there being five cases unpursued for every case there is to fifty. Either way, though, that’s a lot of lawsuits. A lot of malpractice.

          While it’s possible that physicians are unusually incompetent, careless or psychopathic, I suspect the bigger issues is that they are probably in line with the general population but their jobs expose them to liabilities most people don’t have. If I screw up royally a job, a software error might get through. If my wife does, somebody dies.

          Of course, doctors are well paid and we need few enough of them that maybe we can actually recruit some that are geniunely conscientious enough that telling them “Just don’t make (bad) mistakes” is a reasonable position.

          That’s not the doctors’ corps that we presently have, though, and those we have do worry about making mistakes. Even if you could convince them that the innocent have nothing to fear, and even though physicians are a notoriously egotistical lot, it doesn’t take much to realize that a physician’s margin of error in some specialties is much higher than in others, or at this hospital over here is much smaller than that hospital over there.

          For my wife, that means delivering babies is 10% of my wife’s job, and the source of roughly 90% of lawsuit consternation. (She has not been sued, but she has gotten three “scares”.) For a colleague of hers in a similar situation who was sued (he won), it meant to stop delivering babies.

          For physicians in the NYT article, though, it means working for a hospital with patient populations that have fewer conditions that are likely to turn a small error into a debilitating or fatal one, or a non-error will land you in court anyway due to a bad outcome. Even if we decide the latter is entirely fiction, the former isn’t. The likelihood of a lawsuit is likely to go up or down a lot based on who you’re caring for, and I have no difficulty believing it impacts recruiting.

          I don’t know what this means in terms of public policy. I have my own views, but I am obviously pretty biased and maybe my views will change if my wife goes to work for IHS (where she couldn’t be sued). But whether there is a solution to the problem or not, the existence of a problem really does look pretty straightforward to me.

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          • And bear in mind ‘s absolutely correct comments above about “standard of care” and causation as elements of the case. The myriad uncertainties inherent in those two issues are a substantial part of why there aren’t more malpractice cases filed than there are.

            I, however, question the CW that for every case filed there are five more potentially meritorious cases that could have been. “Standard of care” is a damn effective defense for a doctor who has even an ounce of charisma.

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            • I, however, question the CW that for every case filed there are five more potentially meritorious cases that could have been.

              I have no skin in the game so far as any specific number goes, but it is certainly true that many potentially meritorious cases go by. How many depends on what we mean by “meritorious.” My boss doesn’t do medical malpractice, but he has a friend who does. Whenever a possible medmal case comes in the door, my boss does an initial review. If it seems like it might be a good case, he refers it to his friend. He has been doing this for decades. In all that time, the friend actually took on exactly two of them.

              Why do so many go by the wayside? Typically, it is a question of damages versus the likelihood of winning on liability and the cost of bringing the case to trial. The cost is non-trivial. We’re talking high five figures for a basic case, going up from there. You don’t do that even if you are sure of winning on liability unless the damages are high enough to make it worth it.

              On a much lower level, this is why we don’t see many lawsuits for food poisoning. The chicken salad you bought at the convenience store was infected with salmonella, and down you go. But what does that mean? Maybe a visit to the ER and/or your primary care provider, and a few days off work while you lie in bed praying for death. Then you are fine. Total economic damages: a couple thousand dollars. File a claim with the risk management department of the home office. They might give you a nuisance value settlement. But don’t seriously think of going to trial.

              But suppose you have substantial damages such that you are looking at a seven figure verdict. But how sure are you on liability? Liability in medmal cases is a bitch. (Keep in mind that “liability” is a legal term of art only weakly correlated with any general sense of “whose fault was it.”) It’s going to cost, say, $100K to step up and make a spin of the wheel. Who is placing that bet? That is a discussion the lawyer and the client have early on. If the client is wealthy and committed to the case, he might be the one paying those experts. If the client is not wealthy, it will be the lawyer, but only if he judges it a good bet. If they win, the lawyer will get the fronted costs repaid, but if they lose, the lawyer is out of pocket. My boss has a line of credit so he can make these bets, but lose a couple of times and you can’t pay the office rent (or, much more critically, your paralegal’s salary).

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    • It’s an example of what happens to most social services when the party in power has as a central tenet that social services are terrible, and deliberately underfunds them until they fail – so they can point to the failure they caused, and say “see, social services inevitably fail due to their own inherent properties. We must get rid of them.”

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        • As the OG article points out – home care has been gutted, so a lot of the patients in expensive hospital beds are there, not because of a medical need to be there, but because they aren’t quite well enough to go home without some support.

          The cheap, efficient care has been cut, so the only care available is to inefficiently use the expensive kind.

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        • From the linky:

          Though funding for the Department of Health continues to grow, the rate of growth has slowed considerably compared to historical trends. The Department of Health budget will grow by 1.2 per cent in real terms between 2009/10 and 2020/21. This is far below the long-term average increases in health spending of approximately 4 per cent a year (above inflation) since the NHS was established and the rate of increase needed based on projections by the Office of Budget Responsibility (4.3 per cent a year).

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          • If health care spending *must* increase by 4% over inflation every year forever, then it’s going to double in real terms every 18 years. At 15% of the current budget, that means teenager now would see every dollar spent now in the *entire* UK budget (in real terms) spent solely on the NHS toward the end of their lifetimes.

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            • Where does the “must” come from? The current budget grows 1,2% year over year and the curve is bending down.

              I get the inclination to bust national healthcare for a whole slew of reasons, but criticizing it for 1.2% spending increases seems misguided, especially given the US’s record on spending, coverage, accessibility, life expectancy, infant mortality, etc.

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            • If you want to look at which system is controlling costs most effectively in the face of factors like new medical technologies and capabilities, aging population, etc. – compare the US’s healthcare expenditure per capita to other first world countries that have socialized medicine, and where the other factors are similar.

              Of course you already know that answer.

              Absolute budget growth of 4% over inflation is different from budget growth of 4% over GDP growth

              A rising GDP per capita allows a country to buy more and better stuff for its citizens, including more and better health care. The UK’s population and GDP per capita are both growing. In so far as healthier people can work more productively, the NHS can even help fund its own growth in the long term, by ensuring a healthier future work force.

              The NHS was created in 1948. Per https://datahub.io/core/gdp-uk#resource-annual the UK GDP has grown an average of about 2.6% a year, inflation adjusted. It doesn’t entirely offset the 4% growth in the NHS’s budget, but it makes it a lot less scary.

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              • What 1st world country routinely has 4% GDP growth? (Which I think is always measured in nominal terms)

                A ‘fixed’ budget may indeed expand as GDP increases, but if there’s a gap between GDP growth and budget growth, that’s going to catch up with an asymptote eventually.

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                • Sure.

                  The UK’s healthcare expenditure is 10% of GDP and growing at 4% a year (though much slower in recent years), or 1.4% faster than GDP on average.

                  The US’s healthcare expenditure is 18% of GDP and growing at 5.6% a year, or 2.4% faster than GDP on average.

                  When the UK’s socialized healthcare expenditure finally eats up its entire GDP, there will have been no US left for some decades for Republicans to gloat from, just an corporate dystopia owned entirely by private insurance companies.

                  That or asymptotic growth has its limits.

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                  • Right. I just gotta reiterate: it seems strange to me to criticize the NHS for spending increases when they are lower than the socialized parts of the US system (and that leaves out the insurance-based market increases which are higher) while covering everyone in the country at a lower per-capita cost.

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                  • If you want to take the very different systems operating in the UK, Canada, Germany, Singapore, Hong Kong etc. and lump them in a group called “socialized healthcare” and call the U.S. system “everything else anyone’s ever tried,” then I suppose you have a point.

                    I’m not sure why you would want to do that, though. It makes for terrible policy analysis. As does this idea that the welfare state can never fail, it can only be underfunded. At some point, if you want to create better systems, you have to face up to what the stress points are and what the failures are and come up with more ways of making them better than “more funding.”

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                    • If you want to take the very different systems of electing governments – first past the post, porportional representation, instant runoff, all in many variations; unicameral and bicameral systems, republics and figurehead monarchies, and call them “democracy”, and call the Saudi system “everything else anyone’s ever tried” then I suppose you have a point.

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                      • And of course Canada didn’t exist prior to 1966, just like no other first world country existed prior to its own implementation of universal healthcare, so there’s no sense considering the various systems they had and saw fit to get rid of, either.

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  3. HC1: Oddly enough, I’d like my gums to stop regenerating so aggressively. Every few years I have to go in and have my gums hit with a laser to burn them back a few mm so my teeth look normal-ish.

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  4. The Tommy Douglas v. Kennedy story ignores the fact that Earl Warren tried to create a California only version of universal health care when he was governor in the 1940s.

    https://www.newyorker.com/magazine/2012/09/24/the-lie-factory

    The plan failed because doctors and business interests revolted and they used the same kind of propaganda that is familiar today. They portrayed something very close to “death panels” though not in those terms. The propaganda was very much about not allowing government interference with the doctor-patient relationship.

    For a certain percentage of Americans even the vaguest welfare state notions are poison and this is bred deeply in their bones. Luckily it seems to be changing.

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  5. I winAmazon picks NoVa.

    {though I’m sad they didn’t pick somewhere west of the Blue Ridge/Appalachians… would have been better for the country… and I really dislike Megatropoloi and Capitals sucking opportunities from the rest of the regions}

    Ooops… I don’t win… that’s just AWS. I blame my buddy who sent me the article. Yeah, he’s the one who can’t read.

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    • Allow me to see into the future here. There is no recording of the poop orifice comment. It comes from unnamed people who were there. Can we trust those people? Who are the sources? etc etc. Can the press be trusted? Those who say yes will believe he said it and those that don’t trust the WaPo won’t. Many pixels will be spilled.

      Of course we could look at concrete unambiguous actions like removing protections from Salvadoran refugees who have been here for something like 20 years to gauge wtf is going on. Or states pushing for more work from disabled people or their benefits may be cut off irregardless of the harm that may come. But at least we would have policies to debate which are out in the open instead of whether the really crude guy said this one particular crude thing.

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        • Well for one CNN sucks and blows. It wouldn’t surprise me if he said it but i have a, to say the least, rather poor opinion of Trump. There is actual substance though about his plans for various immigrant groups that matters. Maybe the WH will admit he said it. Weirder stuff has happened.

          It’s still a bit of shiny distraction compared to what he is doing. Today they have all these arguments and disagreements over what to do after the highly touted “He held a good meeting” deal yesterday.

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          • I don’t think this one is a shiny distraction* but shows people who try to deny it what a racist bigot Trump is. No hiding from this one. No fig leaf of deniability allowed.

            But I agree that CNN is atrocious.

            *It’s in the eye of the beholder I admit.

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            • If they are going to deny it, they are going to say there is no proof he said it. Who claims he said it and do the other people confirm it. If Lindsey Graham confirms it that will be something since Graham has gone full lick spittle to Trump.

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                • I think that it will shore up his base

                  Shore them up from what? They’ve never deviated in their support of him so they don’t need any shoring, seems to me. His base isn’t the R-voting electorate, it’s the tiny fraction of the electorate which elected him in the GOP primary. He can’t lose those people. What he keeps losing are traditional conservatives and right-leaning independents who voted for him on a bunch of unfulfilled promises/expectations.

                  My prediction: this further erodes his approvals.

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                  • My prediction: this further erodes his approvals.

                    Yeah, that seems likely too.

                    But I think that this debate will evolve weirdly and I’m trying to come up with something that I can see happening that will be measurable and we’ll be able to point to that isn’t freaking obvious and banal.

                    We’ll see how this plays out over the next few days.

                    But I suspect that this isn’t a slam dunk hurray Trump got an own-goal and now he’ll see that he shouldn’t have said that situation.

                    And I’m already regretting pointing that out because doing so seems to be easily confused with cheerleading.

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                    • Sometimes obvious and banal is correct. We’ll see how far other R’s go in condemning this. It’s not like many R pols have shown all that much spine in taking any actual actions. However we’ll see how the admin’s desire to deport a bunch of people go. That might be a tell.

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                      • I imagine that this will turn a handful of Trump’s #1s into #3s and even a handful of demoralized #2s.

                        I can’t see this turning a whole lot of demoralized #2s into #3s (let alone #1s).

                        As for the #3s, I think that this will start a debate on immigration and why we need to do it. Depending on how the debate goes, I can see a large chunk of #3s deciding to self-sort themselves into either #1s or #2s. We will have *FEWER* #3s at the end of this.

                        And I think that if the message for why we need immigration stays on the whole Jesuit message, it’ll result in a lot more #2s than #1s.

                        But I also see other ways the immigration debate could go that would result in other outcomes.

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                        • Hmmm… now I’m confused. Have you changed the definition of the 1s, 2s, and 3s? I didn’t think it was about moving people between the categories but how much 1, 2, or 3 you accomplished?

                          Here, I’ll quote you:

                          “1) Get Your People Fired Up.
                          You want your people to say “Hells, yeah! I’m voting for my preferred candidate! I can’t wait!””
                          Will this fire Trump people up? More to the point, will it fire up people who aren’t already fired up?

                          “2) Get Your Opponent’s People Depressed.
                          Sure, most of the people inclined to vote for your opponent are never, ever, going to vote for you. That’s not a problem is you can get them to not vote for your opponent. Make them stay home. Make them say “I don’t care who wins.” Make them say “Both parties suck.” Make them *NOT* vote for their guy.”
                          I don’t think this will depress a single Democrat in terms of election impact.

                          “3) Get people on the fence to say “hey, you know what? I spent all that time thinking about the World Series and now that it’s over, I can think about the election. Who is running again? Hey. I think I’ll vote for the candidate the people in example #1 are singing the praises of because the people in example #2 are such downers.””
                          I don’t imagine any fence sitters will look at the Trumpers fired up by “shithole countries” and the anti-Trumpers who are affirmed in their resolve against him and decide that the former is the team they want to join.

                          So… help he understand where I’ve gone wrong in understanding this and your response above.

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                          • Oh, I was looking at it through the context of “shore up his base”.

                            I’ll say Trump Voters vs. Generic Dem voters.

                            For Trump’s side:
                            His #1s are going to have a chunk of them invigorated and another chunk turned into #3s (and a small number of them will be alienated entirely… for example, the immigrants from some of the countries named who preferred the residual optimism of the Reagan Coalition to the emphasis on the welfare state Democrats).

                            I can’t imagine that any Generic Democrat voters were demoralized by his comments. I think they were, instead, fired up.

                            As for the people on the fence, I think that I think that this will start a debate on immigration and why we need to do it. Depending on how the debate goes, I can see a large chunk of #3s deciding to self-sort themselves into either #1s or #2s. We will have *FEWER* #3s at the end of this.

                            And I think that if the message for why we need immigration stays on the whole Jesuit message, it’ll result in a lot more #2s than #1s.

                            As for the Generic Democrat voters, the #1s are fired up and they’re going to fight against Trump with renewed vigor.

                            They see a number of demoralized #2s across the aisle and will do their best to capitalize on that.

                            As for their #3s, I think that I think that this will start a debate on immigration and why we need to do it. Depending on how the debate goes, I can see a large chunk of #3s deciding to self-sort themselves into either #1s or #2s. We will have *FEWER* #3s at the end of this.

                            And I think that if the message for why we need immigration stays on the whole Jesuit message, it’ll result in a lot more #1s than #2s.

                            Is that better?

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                            • I guess I misunderstood this from the start. I didn’t realize there were 1s, 2s, and 3s on both sides. But now I think I get it better.

                              Interesting that you dive into the possible after-effects of this, namely the immigration debate and the potential fall out from THAT. I feel like all the analysis to Hillary’s “deplorables” comment was concentrated on that one (partial) statement. Curious.

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                              • Interesting that you dive into the possible after-effects of this, namely the immigration debate and the potential fall out from THAT. I feel like all the analysis to Hillary’s “deplorables” comment was concentrated on that one (partial) statement. Curious.

                                Well, let’s break it down.

                                Let us first look at Clinton’s Deplorables quotation:

                                You know, to just be grossly generalistic, you could put half of Trump’s supporters into what I call the basket of deplorables. (Laughter/applause) Right? (Laughter/applause) They’re racist, sexist, homophobic, xenophobic — Islamophobic — you name it. And unfortunately, there are people like that. And he has lifted them up. He has given voice to their websites that used to only have 11,000 people — now have 11 million. He tweets and retweets their offensive hateful mean-spirited rhetoric. Now, some of those folks — they are irredeemable, but thankfully, they are not America.

                                So, as a response to that, there was a discussion over whether half of Trump’s support came from “racist, sexist, homophobic, xenophobic — Islamophobic — you name it” people.

                                That’s the ground where the debate took place. Is it half? Are they Islamophobic? Racist? Sexist? Homophobes?

                                So now let’s go to Trump’s quotation and see where the debate will take place:

                                Why do we want all these people from ‘shithole countries’ coming here?

                                Do you think we can debate this without talking about why we’d want all these people from troubled countries coming here?

                                I suppose we might be able to… but the best way that I can see that is by saying that the question is racist, Trump is racist, and everyone who wasn’t a member of the basket of deplorables has left him and anyone who still supports him even now is racist, sexist, homophobic, xenophobic — Islamophobic — you name it.

                                To do it by actually answering the question posed seems to me to be a better way of dealing with the question and the message contained in the Jesuit answer seems to be the best way of knocking that question flat.

                                Because one of the things that was, seriously!, discussed was changing America’s immigration system to one much more like Canada’s point system.

                                And there are reasons that people would support instituting such a point system because they wanted immigrants that would have high scores on that system rather than low ones (with the related assumption being that the majority of immigrants from 3rd world countries wouldn’t have high point scores on a point system).

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                                • “So, as a response to that, there was a discussion over whether half of Trump’s support came from “racist, sexist, homophobic, xenophobic — Islamophobic — you name it” people.

                                  That’s the ground where the debate took place. Is it half? Are they Islamophobic? Racist? Sexist? Homophobes?”

                                  This debate happened? Where? When?

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                                  • Following the speech? That was given on September 9th?

                                    Here’s NPR on September 10th. Here’s a line from the middle of that:

                                    The biggest problem in Clinton’s statement is that she said “half” of Trump supporters are racists, xenophobes and otherwise bigots. Half means equal or near-equal parts. There’s no data to support such a specific number.

                                    Politifact talked about how, the day after she gave the speech, she apologized for saying half. Here’s the quotation itself:

                                    Last night I was ‘grossly generalistic,’ and that’s never a good idea. I regret saying ‘half’ — that was wrong.

                                    Do you need me to find more evidence or are we good?

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                                    • That’s not a debate on whether his supporters were deplorables or not. It was fine tuning how awful she is.

                                      Show me how the fallout to Hillary’s comments in any way compares to your hypothetical immigration debate. Hell, you’re positing there is a path for that debate to turn this comment into a win for Trump.

                                      How could the followup to Hillary’s comments turned into a win for her? Was there a path there? If not, these things are not comparable and your asking us to treat her comment different — worse! — than his.

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                                      • I didn’t say that they had a debate on whether his supporters were deplorables or not.

                                        I said “there was a discussion over whether half of Trump’s support came from blah blah blah” and showed excerpts talking about how she shouldn’t have said “half” and even a link to how she, herself, said that she shouldn’t have said half.

                                        You even quoted me, Kazzy.

                                        Show me how the fallout to Hillary’s comments in any way compares to your hypothetical immigration debate. Hell, you’re positing there is a path for that debate to turn this comment into a win for Trump.

                                        Wait, do we agree that Clinton apologizing and retracting indicates that Clinton’s statement was a political net-negative? I’m not certain that we do.

                                        Are there ways to turn this comment into a win for Trump? I suspect that there are, theoretically, but they involve overreach on the part of the reaction to it rather than on stuff that he, himself, does.

                                        How could the followup to Hillary’s comments turned into a win for her? Was there a path there? If not, these things are not comparable and your asking us to treat her comment different — worse! — than his.

                                        Well, I get the feeling that we’re talking about two different things. I’m talking about a political net positive/negative and you seem to want to talk about moral judgments.

                                        For one, it’s possible to make a statement that is a political net positive that is a political net negative (or vice-versa) and I’m more interested in the political dynamics that are leading up to the 2018 elections.

                                        I’m not particularly interested in the moral judgments.

                                        But to answer your question on a political level, I’d say that Clinton’s “Deplorables” was similar to Romney’s “47%” line where he wrote off an entire group of people some of whom could have conceivably been persuaded to either vote for him or, at least, not be bothered by the choices before them to bother voting at all. How could she have turned it into a win? Well, by editing it before she gave it to “a small core” or something like that. After the fact? Well, I don’t know what she could have done after the fact. Tried to bait her opposition into proving it, I suppose.

                                        But that’s a political thing. Not a moral thing.

                                        (And, for what it’s worth, Clinton herself talks about how that was one of the things that happened that contributed to her loss in her book What Happened.)

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                                          • In the days that followed, I believe that the automatic, could not even be debated, assumption was that of course they weren’t.

                                            Which is why “half” was agreed upon by all (even the person who made the original claim!) to go too far.

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                                            • So, we didn’t actually debate whether or not some segment (maybe half, maybe more, probably less) of Trump’s supporters were Islamophobic, racist, sexist, or homophobic?

                                              We simply decided Hillary was wrong and stupid for being wrong and the entire debacle was a huge L for her.

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                                              • We simply decided Hillary was wrong and stupid for being wrong and the entire debacle was a huge L for her.

                                                It’s worse than that. She, herself, said that she was wrong and to say what she said was not only wrong, but a mistake.

                                                Another example of her not supporting her own supporters.

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                                                • So the issue is that Hillary stupidly and wrongly backtracked in the face of criticism?

                                                  I’m still unclear on where and when we genuinely debated, well, anything in response to Hillary’s comments. And why we ought to use Trump’s statement as a reason to debate, well, anything instead of just calling it what it was: an offensive, stupid, and wrong thing to say.

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                                                    • I said, “Interesting that you dive into the possible after-effects of this, namely the immigration debate and the potential fall out from THAT. I feel like all the analysis to Hillary’s “deplorables” comment was concentrated on that one (partial) statement. Curious.”

                                                      And you then told me about all the debates we did have about the issues relevant to her comment.

                                                      Only… we didn’t have those debates.

                                                      With Trump, you want to talk about immigration… not about “shithole countries”. With Hillary, it was all deplorables, all the time.

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                                                      • With Clinton, we discuss with the benefit of hindsight.

                                                        With Trump, we discuss not knowing what tomorrow or next week will bring.

                                                        Maybe by tomorrow we will have enough information about today to be able to discuss what Trump said yesterday.

                                                        That said, going back to what Clinton said on September 9th, by September 10th, she had apologized and said that what she said was wrong to the media.

                                                        By comparison, Trump is dodging questions like “are you a racist?” at press conferences today.

                                                        It seems like there are two very different dynamics between the two events.

                                                        Is it your position that Clinton made a mistake by admitting that she made a mistake on September 10th?

                                                        If so, you should be interested to see that Trump is not repeating Clinton’s mistake.

                                                        If all you’re hoping for is for me to acknowledge how good and right Clinton was and how evil and wrong Trump is, well, again, I’m not interested in that part of the conversation.

                                                        Let’s agree to assume that Clinton was good and right and Trump is evil and wrong if it will let us get past that.

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                                • This is mostly an aside and I don’t doubt that people were talking about the Canadian system in such terms as you describe, but I’d just like to point out that refugees, asylum seekers, and other people in that “desperate straits” category are *exempt* from the points system in Canada. Canada prioritizes as immigrants, more or less in order:
                                  1) people who need it most, as per Fr. Martin’s message above (and as an aside to my aside Fr. Martin, whom I appreciate a great deal, is pretty left-of-center even for a modern Jesuit, I’m not sure it’s the Official Jesuit Response)
                                  2) people with a bunch of money to invest (the cynical might suggest this is actually #1, but I mostly don’t agree with them)
                                  3) people who score big shiny scores on the points system.

                                  So presenting it as a pure “meritocracy”, whoever is doing that, they’re very wrong.

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                                  • “refugees, asylum seekers, and other people in that “desperate straits” category are *exempt* from the points system in Canada”

                                    Of course, of course.

                                    The debate assumed a pure meritocracy without taking into account the two categories of people who get priority before that part.

                                    So skipping over those two categories, I stand by that people were, seriously, discussing a point system like Canada’s third category of prioritized immigrants, though.

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                        • Jaybird,

                          I think it’s possible the pro-Trump media machine can turn this into a win. It’s more likely that they can’t and take their lumps while spinning it enough to keep their base fired up. But just the fact that we talk so often about whether Trump can or will turn what used to be an obvious own-goal into wins makes me think that we’re getting closer and closer to an own-goal tipping point leading to a Trump free fall (except for the crazy 27%).

                          If some single event brings Trump down I’m starting to think it’ll be something like the comments he made today rather than a bombshell indictment by Mueller or a Breaking News story identifying a smoking Russian Collusion gun. It’ll be something we can’t predict right now, something which seems just like so many other own-goals, and it’ll flip only a handful of people’s sentiments. But it’ll be the last crack that breaks the dam wide open.

                          And by “breaks the damn wide open” I mean shifting public sentiment so radically it results in impeachment.

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                          • One hopes.

                            But I still see this ending in divorce or war and I’m not certain that anything but a resounding defeat of Trumpism so devastating that NOBODY even talks about looking at it again will succeed at preventing that sort of thing.

                            Like, I’m talking about losses that will make the response to the AWB look like statistical noise.

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                            • Well, it’s not so much a hope as a recognition that conventional norms and institutions probably won’t be sufficient to bring him down. The entire GOP machine is mobilized to prevent those mechanisms from resulting in major political damage. What I’m saying is IF it happens it’ll much more likely be a combination of fatigue and disgust in the electorate which percolates back up thru GOP CCers in both houses. I don’t think we’re very far away from that in terms of polling, but never underestimate the heart of a champion. :)

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                        • Jaybird: As for the #3s, I think that this will start a debate on immigration and why we need to do it.

                          Re: ‘start’. The current immigration debate goes back to the mid 80s. It’s been at an impasse since Bush Jr’s re-election, through the gang of eight, and onto Trump’s nomination and improbable election.

                          The issue is beyond ripe.

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                  • this further erodes his approvals.

                    Sadly, no.
                    Is there anyone in America, anyone at all, who is surprised in the least that Trump speaks this way? Is this somehow giving us new information about the man and his supporters?

                    Notice I included “his supporters” because I don’t believe they will be shocked, saddened, disappointed in the least.
                    They love the fact he speaks this way, and will only applaud him.
                    If some break away, well, good for them, but I am not optimistic on that score.

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                      • The silver lining I suppose is that Trump is in his own way, “heightening the contradictions”, forcing people to make a choice.

                        As long as people could vote for a McCain, or Cruz, or Romney, they could tell themselves semi-plausibly that they weren’t racist or xenophobic.
                        But as they say, Trump says the quiet parts loud.

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                        • Do we really want them to stop telling themselves that, though? Or is being able to tell themselves that, and believe it enough to move toward (and/or be nudged toward) it being more true than it was yesterday, rather than less, actually *good* for the rest of us?

                          I have no particular desire for anywhere *near* 27 percent of the American public to be more sure they hate people they don’t think are like them enough, rather than less sure of that.

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                            • From my perspective, even if I 100 percent agreed with your premise, that’s cutting off our collective nose to spite our collective face. Though I certainly understand the desire to show the face whatfor given its absolutely abysmal choices of late, and have had some spectacular fantasies about how, if forcibly freed of the nose, the face would improve, rather than the entire body bleeding out instead. Still, the body bleeding out seems rather more likely.

                              But I also do have some parts of me that hope that shunning and shaming will work, rather than making it worse. I mean, it *does* work, historically, it’s effective against all kinds of bad actors in all kinds of situations (as well as against good actors in awful situations. basically, it’s super-effective.) I’m just not buying that it can work in a country as big and as segregated as this one, and I’m even more intensely worried about what will happen if it doesn’t.

                              Generally speaking, whatever major shit hits the fan, hits the worst off among us first. Makes it worse for them than it already is.

                              May history prove me wrong that that will happen – I am aware that a similar attitude to my own might’ve called off the great civil rights marches of the 60s before they had a chance to get started. I mean, f’ing Joe Arpaio is getting national attention for running for the senate now??? It *is* disgusting. He should be in jail, not benefiting from the benevolent appreciation of a despot constrained only by a system that is designed to resist despotry.

                              Some actual eye-opening insights and self-awareness on the part of those who approve of Trump would be nice. Perhaps country-saving. I just suspect that if shaming was going to work, they’d have achieved those things by now.

                              Of course I also suspect nuclear war (currently at 4:1 odds against in my internal bookmaking schema), so.

                              My *hope* is that carrot and stick will work (outreach AND condemnation, from different quarters), because that’s what’s actually happening. So if it doesn’t, we’re all fished.

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                                • I read the article.

                                  There was not one mention in the article of any policy preference that wasn’t about culture and identity politics of white Christians. Not one.

                                  They talked about guns, abortion, Muslims “metro-centric people and trans people.

                                  But not healthcare, even though they mentioned the opiod crisis in passing, like it was a twister, an act of God.
                                  They didn’t talk about unions, or tariffs or NAFTA or any kind of government policy that might relieve their “economic anxiety”.

                                  They really, really, despise the people in the Democratic party. Not the party platform. The people in the party, the Metro-centric Muslim trans people who get abortions.That much is clear.

                                  Even the writer and the politician put together couldn’t offer up one single idea of how to get these people to vote Democrat.

                                  But somehow it is the Washington Metro- centric people who are the problem.

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                                  • Yeah i had the same reaction. What concrete things do the pols they talked to want? One guy even talked about changing his views/votes on gay marriage ( which is great but doesn’t bolster the point of the piece) but they just didn’t want it shoved down their throats or something. Which is something that is really happening in rural Indiana i’m sure. Other than that is was a lot of cultural markers and Foxisms: Elites, elites, they don’t know real america. What do they want and does it cost the votes of other D constituencies.

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                                    • You’re forgetting the part where it says Democrats hold the fewest offices across the country since the 1920s. The takeaway for me was this line:

                                      In a nutshell, this is the advice of Bustos’ report: Widen the definition of Democrat.

                                      But I’d phrase it differently. The national party decision-makers who impose platform commitments on candidates in exchange for monetary and logistical support shouldn’t expand the definition of “democrat”, they shouldn’t even try to define it. Let candidates who know their own states and districts run on any platform they want under the D party. If they get elected, they’re a Democrat. More populist/moderate/conservative Dems in office are better for the party than those seats going R.

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                                      • But is that what the people in the piece want? I’m fine with conservative D’s in general but there does need to be some policy/ideological coherence to any party. That is the point of a platform. Having D not mean anything doesn’t really help actually getting anything done once you get elected.

                                        I’d keep the platform pretty narrow: uni health care would be top of my list. If you have 3-5 basic items in your platform then locals can go their own way so i don’t really disagree.

                                        How narrow is the definition of D now? I’m not really sure. What is the definition of a Democrat?

                                        As i remember doesn’t every group of POC’s vote for D’s mostly and a substantial minority of white folks. Yeah i know how that has worked out in elections ( leaving gerrymandering aside). But that is pretty wide party. D’s have had anti- abortion members, that isn’t actually new but its not like the party as a whole is going to go anti Abortion. They would be better off to talk about guns less.

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                                        • Maybe what I’m saying is that part of the reason people hate the Dem party right now is *because* it’s narrowly run by national committees. Voters know what it means to be a Democrat: in part it means centralized (donor/powerbroker) control of national platform and national messaging. Why think that the same messaging that gets Pelosi elected in SF will work in Stillwater OK? (Rhetorical Q. I know you know the answer.)

                                          there does need to be some policy/ideological coherence to any party.

                                          Sure, but shouldn’t that coherence be determined in part by voters responses to a fresh set of ideas?

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                                  • So I tucked Jaybird in and we talked about all the problems I saw with said article and the parts that made me anxious and more worried, not less… and then I curled up with my laptop and saw this comment and I find myself wanting, in vexation, to ask what the heck article you *read*?

                                    You:
                                    “There was not one mention in the article of any policy preference that wasn’t about culture and identity politics of white Christians. Not one.

                                    They talked about guns, abortion, Muslims “metro-centric people and trans people.

                                    But not healthcare”

                                    Article, 2nd paragraph:
                                    “He wanted to talk about the importance of public education, affordable health care and a living wage, and the moral necessity of addressing the opioids scourge.” (my emphasis)

                                    You:
                                    ” they mentioned the opiod crisis in passing, like it was a twister, an act of God.”

                                    Article:
                                    “Two years ago, Goodin’s hometown of Austin, population 4,200, was the epicenter of “the largest drug-fueled HIV outbreak to hit rural America in recent history,” in the words of the Centers for Disease Control and Prevention. Resulting mostly from the sharing of dirty needles to shoot painkillers,(my emphasis – but that’s not a twister description, seriously! it’s a public health description)

                                    You:
                                    “They didn’t talk about unions”

                                    Article:
                                    “Goodin’s Indiana District 66 went heavy for Trump. One reason: It used to have plenty of decent-paying, union-boosted jobs, anchored by the Morgan Packing plant. Now, there are far fewer, and paychecks for the ones that remain have gotten smaller.”

                                    ” Goodin is a Democrat in the first place, he told me, because his grandfather was a union coal miner in Harlan County, Kentucky” (granted this one is identity-related but it’s also *union* identity)

                                    You:
                                    “Even the writer and the politician put together couldn’t offer up one single idea of how to get these people to vote Democrat.”

                                    Article:
                                    “Here in this not even 10-minute interaction, I thought, was the nub of the Bustos report—and the challenge it presents to party leaders who will be asked to grapple with its primary recommendation that Democrats focus on economic matters and steer clear of confrontation on contentious social issues.

                                    “But Delmis Burns and I probably agree on 90 percent of everything we’d ever talk about. So why would I focus on the 10 percent that I don’t agree with him on?” (explaining how he believes he wins, implying thusly that he recommends focusing on shared values, not contentious ones).

                                    Do I like that recommendation? No I do not. Does it seem like a pretty darn clear recommendation? Yep, it sure does.

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                                    • FWIW, I am still very much frustrated with the article and with the to-me glaringly clear recommendation, because I don’t at all agree that that’s the only way to win. I don’t think it’s the most effective OR the most moral way to do anything. In my most hopeful moments I would like to think that if you talk to people about the 90 percent (or even 30 percent) of things you agree on, it can often be a bridge to being able to have hard and necessary conversations about the things they make you want to spit nails about (and vice versa).

                                      And then there are lots of other options that don’t involve pretending like you don’t care about their bullshit beliefs that mess with other people, like *simultaneously* hammering jobs AND bathrooms while not also awkwardly implying that you think they are deplorables when what you (generic HRC-esque Democrat politician you, of course, not specific Chip you, who thinks they shouldn’t have a figleaf) meant to do was more like say “hey, you guys aren’t mostly deplorable but you need to stop listening to those few among you who are, and letting them lead you around by the nose.”

                                      Danica Roem, for eg, did an amazing job of this, and kicked out a state legislature Virginian incumbent – she managed to simultaneously make it a cheerful, powerful victory explicitly for people who just want their damn local services to work and don’t care as much about identities they don’t take for granted, AND an explicit jubilant victory for trans people and outcasts across the country. That’s what the party needs, as far as I can see.. More people like her. And I think people like *her* are smart enough to listen to people like Goodin, and find what common cause they can, even when they disagree with them intensely.

                                      More power to her, frankly – there’s a reason why I left my rural place of birth, and it wasn’t to marry Jaybird. I was shaking the red PEI dust off my shiny new Montreal combat boots the *second* I could get into my freshman dorm. But just because I can’t live with people like that doesn’t mean I don’t see them asking to be treated, with, well, to use your own words, words I also value: dignity and respect.

                                      Dignity and respect are the way to get the votes of unemployed opioid-addicted can’t-anymore-farmers. I might not always feel like they’re earning it – sometimes I might feel like they’re *begging* to not be accorded it considering how skeptical they are when other people ask to be treated in the same way – but offering the promise of treating people that way is hardly a novel vote-swaying strategy. It should be old hat for Democrats by now, considering it’s the exact same strategy they use to win over me and people like me, just with different stuff at the forefront. No one will believe in promises of public healthcare and strong public education if they don’t believe the politicians promising those things actually value them as people.

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                                    • I should have clarified-
                                      The Dem politician wanted to talk about traditional Democratic Party issues like unions and healthcare-
                                      But the constituents don’t!

                                      They want to talk about culture war stuff.

                                      Yes, its been noted over and over again how the white blue collar rural people actually do agree with the Democratic party on virtually every issue.

                                      Except the ones that matter to them, which are abortion, immigration, and gays.

                                      The Republican Party is constructed now, almost entirely, on white cultural resentment.

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                                      • The article’s point, I believe, is that if you don’t confront constituents like Goodwin’s about their dumb culture war stuff, you can get their support on things like healthcare and unions. And then eventually (due, ironically enough in large part to Democratic majorities) the other stuff becomes settled law and they accept it and stop trying to get it overturned.

                                        As noted at length already, I disagree with them about the potential for confrontation once people trust you. But I’d rather that politicians make everyone’s lives better than punish/shun/excoriate the people who want to make my life worse.

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                                        • I think some of disconnect here is that D’s spent pretty much a year focused on health care and have talked about unions and all those concrete issues yet there is set of conservative people who keep saying all D’s do is talk about culture war. D’s do plenty of the stuff conservo D say they want yet it’s either never enough or something unspecified.

                                          I’m sure i dont’ hear all the stuff they do given my own media consumption habits. But i do know that whenever i see RW media they are almost always hammering culture war stuff with the same shallow quips about elites or some such. I’ve been hearing how some people are less american in some way as long as i’ve been politically aware. Should D’s focus like a laser or maser or phaser on stuff like Uni health care? Yeah i’d personally like that and i think it would be a winner. But i also think many of the conservo D’s would have the same complaints because they are pretty much repeating foxisms and have their own racial issues. It’s not like focusing on health care was great for D’s in 2010.

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                                          • That’s fair, and I appreciate your take on the article more generally. I just had a laundry list of issues with @chip-daniels’ characterization of it. He was describing a very different article than the one I read.

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                                        • I disagree with them about the potential for confrontation once people trust you.

                                          But how do you gain that trust? Treating them with respect and dignity will go a long way, but part of getting their ear will include distancing yourself from issues which make those particular voters inherently distrustful of your motives and ideological orientation, yes?

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                                            • From what I understand her campaign rhetoric didn’t include any of the national party’s identification markers. As you said upthread, she ran on a local platform appealing to local issues. Her gender/identity or identity politics more generally weren’t an issue because she didn’t campaign on that as an issue. And voters responded.

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                                              • She didn’t campaign on it as an issue but she did talk about it freely, and emphatically, when asked. And she campaigned on the general platform of anti-discrimination as an issue (rather than actual specific laws) in response to the other candidate’s bullshit. I mean, she had an ad showing herself putting on makeup, taking spirolactone, and then a bunch of faces of trans teens (also not all white kids) flashing past. That’s identity politics, it’s just well-crafted, “you go low we go high” identity politics with a “and back to this local issue!!!” ending. Focus. Not denial.

                                                That’s the needle I think people *can* thread, and should, and that, say the Dem party of the 90s didn’t feel any moral obligation to. Not “make this the central issue” but “refuse to pretend you aren’t who you are and you don’t believe what you believe”.

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                                                • That’s the needle I think people *can* thread, and should, and that, say the Dem party of the 90s didn’t feel any moral obligation to.

                                                  Roem threaded it. She strikes me as an extraordinary person and candidate.

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                                                  • Yep. And I don’t think the Democratic Party can break the back of fearmongering appeal, in a moral way at least, without extraordinary candidates. I happen to think they can find them.

                                                    Of course, I also think that if there hadn’t been a fancy Washington reporter standing right there, changing the nature of the dynamic, Goodwin would’ve been more likely to nudge whatshisface about his Islamophobia. Embarrassing people in front of outsiders is a 100 percent no-go move. Doesn’t mean the conversations don’t get had in less contentious circumstances.

                                                    It’s arguably inconsistent to be so optimistic and so pessimistic about human nature at the same time, but that is how I see it.

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                                                    • Maybe the point of disagreement between us isn’t so much the direction the Democratic party should take, but the direction we’re viewing the Dems’ current problems from. My perspective is that Dems aren’t competitive in lots of districts because Dem policies are too narrowly tailored to national appeal, and too narrowly associated (correctly) by Dem detractors as taking all the local out of politics. My solution is to allow Dem candidates to tailor their own platforms and messaging for their own constituencies in order to bring back some of that localness.

                                                      The downside risk is that Dem candidates might abandon some of the signature issues and commitments the national level party identity is based on and which lots of people believe *should* be preserved and even advanced. So the two things are in tension: what if, as is the case actually, Dems who are too closely associated those particular policies and commitments can no longer get elected in what used to be purplish districts? Is the problem with the messaging? The policies? The voters? (This last one is the Dems most common answer.)

                                                      I’m not sure how the Democratic party can stay committed to X, Y and Z as a party identity (whether that identity is justly perceived or not) and retain enough political influence to promote X, Y and Z. Can’t have that cake and eat it too.

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                                        • No, you can’t get their support.

                                          Goodin himself even says so, inadvertently.
                                          He complains that the people already agree with him on 90% of Democratic issues, but still vote Republican.

                                          Because that 10% is of utmost importance to them!

                                          There simply is no way to “not confront” them on that 10%, because they themselves seek it out, pursue it, turn over rocks to find it.

                                          “Here is my plan for affordable healthcare”
                                          “Yeah, but what about Katie Steinle being killed by that Mexican?”

                                          “Lets talk about trade policy and your agriculture interests”
                                          “Hey, do you support those black athletes disrespecting our troops?”

                                          We should stop giving away tax cuts to billionaires.”
                                          “Do you promise to confirm judges who are pro-life?”

                                          These people are not isolated on some island somewhere; They have Fox News and Facebook and Gateway Pundit piped into their homes 24/7, a constant drumbeat for the culture war of white ethnic grievance.

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                                          • Also and furthermore, I actually *know* some of those people and yes, it’s hard to get along with them and I often can’t be bothered, but when I do bother, *that’s not how the conversations go*. Your imago of those people is perhaps an accurate description of their media, but it’s not an accurate description of one-on-one interactions with a very capturable segment of them.

                                            I agree that what works for Goodin may not work on the national level for Presidential candidates, and that he doesn’t see that – but can you see that what he describes *is* working for him, and for individuals on an individual level? He’s not making up some stuff that maybe could work for somebody somewhere, he’s talking about what he actually *does* to stay in office.

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                • Tucker Carlson tweeted:

                  Option A: El Salvador isn’t a “shithole,” so they don’t need 17 years of Temporary Protected Status, and migrants from there should be sent home immediately. Option B: El Salvador is, in fact, a “shithole.”

                  We can assume Tucker has an natural intuitive feel for a rich vein of sleaze.

                  It will shore him up with the people who are already all in for him. It will disgust plenty of moderate centrists and R’s. Especially those that mission to such places. Oh btw Orrin Hatch seems to be coming out strongly for Trump to explain himself.

                  Trump will always have mid 30’s of people who will approve of him. If things go bad for him that might go down to 27%. There are a lot of people in the rest of country.

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    • Senator Hatch said this: ““I look forward to getting a more detailed explanation regarding the President’s comments. Part of what makes America so special is that we welcome the best and brightest in the world, regardless of their country of origin.”

      This sorta feels like a great response. But, is it? The implication seems to be, “We’re happy to take smart talented people even if they come from shithole countries.” Now, I don’t think that was what Hatch was actually thinking or meant to say. But his comment stops way short of saying, “Actually, no, those aren’t shit hole countries,” and takes a nice little dance towards merit-based immigration.

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    • Yeah, there is a predictable pattern to this. Trump says something which is crude on its face and entirely unbecoming of a presidential candidate/President of the United States and yet completely in line with how lots of people feel and firmly within the tradition of U.S. policy (our immigration system was based on national-origin quotas until 1964 and you can guess which countries got the lowest numbers). In response to this, a bunch of people get various degrees of outraged while another bunch of people love the fact that the people they hate had their feelings hurt. Rinse. Repeat.

      My fatigue with this cycle hit its high point sometime around early 2016. I decided to stop playing. Trump is a turd, who represents a very regressive view of what the United States ought to be. I’ve known this since the 80s. I’m not going to be triggered by him continuing to prove it. I don’t really understand what’s keeping so many others in this game.

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      • The fact that he’s President, and those of us that detest him for entirely justifiable reasons are constantly told [1] that people who like him and the fact that he talks this way, have valid grievances, and deserve our sympathy and support.

        Trump’s elevation to the Presidency has gotten half the political world, more or less, invested in an endless game of defending the indefensible, and justifying the un-justifiable. If he were just the same old, rich, crooked fuck he was in 2015, it would be one thing.

        But he’s not.

        EDIT: As for being entirely in line with US policy, this is arguably true. Yet for decades, the people advocating these things (on immigration, law enforcement, voter suppression, and foreign policy especially) have vehemently insisted otherwise, and said they were motivated by lofty principles entirely unrelated to the kind of crude bigotry Trump expresses.

        He’s finally showing everybody what’s on the end of their fork.

        [1] In outlet after outlet, including this one,

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        • This brings up an interesting thought that hadn’t quite occurred to me prior…

          A big fallout from Trump’s win was admonishing liberals/elites/Dems for not listening or understanding the WWC/Middle America/conservatives. Some of us took heed to that and did, indeed, try to further our understanding.

          Now you’ve got lots and lots of folks upset about Trump, his supporters, and what they represent. And often the response to the voicing of this upset is that we are overreacting or ought to quiet down or why do we let it bother us. At any point, will Trumpers/GOP/conservatives/whomever be told that they ought to listen to “The Resistance”?

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          • No because inside the media there is a deeply held belief that only conservative values deserve innate respect and therefore must be listened to . Liberal voices will always be commie Pinko Traitors, and therefore suspect

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      • How is what Trump said unbecoming when a great many Presidents, including Clinton and especially Johnson, were often far cruder? Johnson was so bad that if he were around today Twitter and Facebook would ban him.

        And of course it’s been quite amusing watching media pundits argue that Haiti isn’t a s******* when everybody in the country knows it is exactly that. It’s especially amusing coming from reporters who undoubtedly refer to West Virginia, Mississippi, or Louisiana as a s******* whenever they get sent there.

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