Health Care Policy Briefs: Early Retirement, The Two Americas, Sabotaging Obamacare, Marijuana Not A Gateway Drug, And The Pentagon’s Plan For The Zombie Apocalypse

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Five  health care policy items today:

Goldman issued a report on how availability of health insurance allows people the option of retiring early (or as Republicans would put it, become takers) as opposed to waiting until they qualify for Medicare. The found that “the annual probability of retirement–i.e., what share of workers of a given age will retire within the next year–is on average between 2% and 8% higher when retiree health insurance is available.” Early retirement is seen more between the ages of 60 to 64, than in those who are age 55-59.

With Republicans blocking Medicaid expansion in twenty-four states, The Commonwealth Club looked at the healthcare differences in the two Americas:

The Commonwealth Fund’s recently released Scorecard on State Health System Performance, 2014, finds big differences between states on measures of health care access, quality, costs, and outcomes. What’s more, its authors warn that these differences could very well widen in the future. Many of the lowest-performing states are choosing not to expand their Medicaid programs under the Affordable Care Act (ACA). Some also are discouraging eligible uninsured citizens from purchasing subsidized coverage through new ACA marketplaces, though some uninsured are signing up nonetheless.

The fact that so many low-performing states are spurning the ACA’s benefits, while high-performing states are rushing to embrace them, raises profound questions for the future of our country. What would it mean if different parts of the United States find themselves on radically different health care trajectories, with some enjoying progressively better health and health care and others falling further and further behind? In other words, what would it mean if the two health care Americas grow further and further apart over time?

This is unexplored territory for health care researchers and policymakers, but we know enough to point to some possibilities.

To begin with, we know that when people have health coverage they live longer, healthier lives. Widening gaps in rates of insurance coverage between low- and high-performing states will almost certainly lead to growing differences in life expectancy and health status. This is worrisome and regrettable, but probably only part of the story.

An equally important—but much less explored—question is whether differing health care trajectories also will lead to differing economic and social trajectories. All else equal (of course, it never precisely is), will regions with poorer health care and health status suffer economically and socially as well? Will they have less productive workforces, less productive economies, and, as result, lower quality of life overall? Will they become less attractive places to live, work, and do business?

Several lines of evidence suggest that diverging regional health care systems could lead to diverging general welfare. First, untreated physical and mental health problems increase workers’ time off from work, reduce performance while at work, and lower rates of employment. In the early 20th century, infections such as yellow fever, malaria, and hookworm greatly hindered the economy of the American South. In his memoir, Jimmy Carter recalls that, while growing up in rural Georgia, “almost everyone was afflicted from time to time with hookworm,” a parasite that causes anemia, malaise, and fatigue. Eventually, public health measures and improved living conditions brought this and other health problems under control, contributing to a burst of economic growth.

A century later, chronic illness is the equivalent of the infectious illness that once disproportionately taxed the economy of the American South. In the United States, annual productivity losses from diabetes and depression alone exceed $100 billion nationally. And we know this burden can be lightened through good primary and preventive care that will be less available in regions with large uninsured populations.

Second, health insurance boosts economies by protecting people against catastrophic out-of-pocket health care expenses. These costs can lead to bankruptcy, which raises the cost of borrowing for the rest of society as lenders take into account the risk that they will not be repaid. Those avoiding bankruptcy often incur substantial medical debt, with far-reaching consequences. A 2012 Commonwealth Fund survey found that 61 percent of uninsured adults ages 19 to 64 reported problems paying their medical bills or said they were paying off medical debt over time. Among these individuals, more than half said they received a lower credit rating as a result of unpaid medical bills, 43 percent used all of their savings to pay their bills, and 29 percent delayed education or career plans. The 2006 Massachusetts health reform, which has led to nearly universal health coverage, has also led to fewer personal bankruptcies and bills past due and improved credit scores, particularly for those with limited access to credit before the reform…

The report continued to discuss further differences resulting from differing access to health insurance.

Besides blocking Medicaid expansion, conservatives are reducing the number of insured with misinformation campaigns and campaigns to outright dissuade people from obtaining coverage in the exchanges. This has led many uninsured people to fail to obtain coverage through the exchanges to based upon misconceptions spread by conservatives, such as that the cost would be much higher than it actually is. Jonathan Cohn wrote:

About half of the people who McKinsey surveyed did not end up buying insuranceeither because they shopped and found nothing they liked, or because they didn’t shop at all. When asked to explain these decisions, the majority of these people said they thought coverage would cost too much. But two-thirds of these people said they didn’t know they could get financial assistance. In other words, they assumed they would have to pay the sticker price for coverage, even though federal tax credits would have lowered the price by hundreds or thousands of dollars a year.

With a little education and outreach, many of these people will discover that insurance costs less than they thought. When next year’s open enrollment period begins, they are more likely to get coverage. But the idea was to help more of those people this year. And if the administration deserves some blame for this shortfall, its adversaries deserve more. Republicans and their allies did their best to taint the lawand, where possible, to undermine efforts to promote it. Without such obstruction, even more uninsured people would probably be getting coverage right now. As Sprung quipped in his post, “Those who deliberately spread disinformation about the ACA and actively encouraged the uninsured to remain in that blessed state of freedom can be really proud of themselves.”

Or as I put it in a recent post: Fox Lied, People Die.

The National Bureau of Economic Research looked at the effects of legalization of medical marijuana on drug use:

21 states and the District of Columbia currently have laws that permit marijuana use for medical purposes, often termed medical marijuana laws (MMLs). We tested the effects of MMLs adopted in seven states between 2004 and 2011 on adolescent and adult marijuana, alcohol, and hard drug use. We employed a restricted-access version of the National Survey on Drug Use and Health (NSDUH) micro-level data with geographic identifiers. For those 21 and older, we found that MMLs led to a relative increase in the probability of marijuana use of 16 percent, an increase in marijuana use frequency of 12-17 percent, and an increase in the probability of marijuana abuse/dependence of 15-27 percent. For those 12-20 years old, we found a relative increase in marijuana use initiation of 5-6 percent. Among those aged 21 or above, MMLs increased the frequency of binge drinking by 6-9 percent, but MMLs did not affect drinking behavior among those 12-20 years old. MMLs had no discernible impact on hard drug use in either age group. Taken together, MML implementation increases marijuana use mainly among those over 21, where there is also a spillover effect of increased binge drinking, but there is no evidence of spillovers to other substance use.

If marijuana turns out not to be a gateway drug, this would be another reason to reevaluate current marijuana laws. Further discussion at Vox.

The Pentagon has contingency plans for any emergency, including the Zombie Apocalypse. It isn’t as ridiculous as it sounds as it is actually a model plan using a fictional situation, as reported by Foreign Policy:

“This plan fulfills fictional contingency planning guidance tasking for U.S. Strategic Command to develop a comprehensive [plan] to undertake military operations to preserve ‘non-zombie’ humans from the threats posed by a zombie horde,” CONOP 8888′s plan summary reads. “Because zombies pose a threat to all non-zombie human life, [Strategic Command] will be prepared to preserve the sanctity of human life and conduct operations in support of any human population — including traditional adversaries.”

CONOP 8888, otherwise known as “Counter-Zombie Dominance” and dated April 30, 2011, is no laughing matter, and yet of course it is. As its authors note in the document’s “disclaimer section,” “this plan was not actually designed as a joke.”

Military planners assigned to the U.S. Strategic Command in Omaha, Nebraska during 2009 and 2010 looked for a creative way to devise a planning document to protect citizens in the event of an attack of any kind. The officers used zombies as their muse. “Planners … realized that training examples for plans must accommodate the political fallout that occurs if the general public mistakenly believes that a fictional training scenario is actually a real plan,” the authors wrote, adding: “Rather than risk such an outcome by teaching our augmentees using the fictional ‘Tunisia’ or ‘Nigeria’ scenarios used at [Joint Combined Warfighting School], we elected to use a completely-impossible scenario that could never be mistaken for a real plan.”

But do they have plans in case of a Dalek invasion?

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Democrats Need A Message

One reason that the Republicans get people to turn out to vote in off year elections, often to vote against their economic self-interest, is that they have a message. The message might be based upon dishonest claims and incorrect views as to how the economy and government work, but it is a message. In contrast, many Democratic voters feel less interested in turning out to vote, especially in off year elections. To some degree the Democrats have difficulty in defining a message as they are a big tent party which wins elections by appealing to a wide variety of voters, ranging from center-right to left wing. Issues which appeal to some Democratic voters might turn off others.

The Washington Post describes how Senate Democrats are struggling to define a message:

Senate Democrats’ latest effort in that regard is a 10-point plan for legislation they intend to bring to the floor over the spring and summer.

The issues are familiar ones for Democrats, and poll well among Americans generally.

Yet they are top priorities to narrower slices of the Democrats’ constituency — particularly those who showed up to vote for President Obama in 2012, but who do not have a history or voting in off-year contests.

The first items up for Senate debate will be increasing the minimum wage, from $7.25 an hour to $10.10 an hour, and a bill to assure paycheck equity between male and female workers.

Democratic pollster Celinda Lake said that those are measures that would have their greatest impact on young people, unmarried women, Latinos and African-Americans — all of whom can be difficult to turn out in years when there is no presidential election.

“This doesn’t replace a broader economic message. In the long run, we have to do that. But in the short run, this is very helpful,” said Lake, who has warned that the Democrats face a large turnout disadvantage in a year when Republican voters appear to be more motivated.

GOP pollster Neil Newhouse said the Senate Democrats’ targeted strategy echoes that of Obama’s 2012 reelection campaign, where he emphasized a number of “niche group” issues such as the Dream Act, mandatory contraception coverage under the Affordable Care Act, student loan expansion and support for same-sex marriage.

Why haven’t Democrats been pushing for legalization of same-sex marriage more strongly in the past? As Michigan and other states saw recent legal victories for marriage equality I thought that, although this is an issue far more associated with Democrats than Republicans, the victories are in the courts and not the result of actions by the Democratic Party.

Perhaps Democratic leaders did not want to be associated with bringing about marriage equality out of a fear of losing socially conservative Democratic voters. Maybe, but I also wonder how many socially liberal people who lean Democratic don’t bother to get out to vote because of not seeing a real commitment from Democratic leaders for liberal causes.

Republicans have learned that people tend to take on the other views of the party they associate with when there is a consistent message. They get social conservatives to back their economic policies by joining these as a common conservative philosophy. If the Democrats were to put out a more consistent message, perhaps those who vote for Democrats for other reasons would also “evolve,” as Barack Obama has, on issues such as same-sex marriage.

Democrats should frame this as a consistent platform of keeping government out of the private lives of individuals, along with support for reproductive rights and ideally an end to marijuana prohibition (or at least a stronger defense of medical marijuana). It is amazing that Democrats have allowed Republicans to take an advantage on issues which should be seen as reasons to vote Democratic, from size of government as it relates to private lives to support for Medicare.

Democrats also think too small on economic matters. Rather than just concentrating on issues such as increasing the minimum wage, Democrats need an economic message showing how Democratic ideas strengthen and grow the economy while Republican economic policies lead to economic stagnation and a concentration of wealth in a small minority. Income inequality is an important issue, but only when placed in an overall economic message of expanding the economy and how extreme income inequality destroys the middle class. An economic message seen as merely dislike for the rich (or the Koch brothers) will never sell.

Of course making a coherent economic message which will not only mobilize their own voters but bring in new voters will take time and cannot be done in only one election year. The Republicans have been working for years at indoctrinating the country in their type of Voodoo Economics. It will also take several years to get out the message on how the economy actually works, but the Democrats might as well start now.

Health care remains one of the strongest reasons to vote for Democrats. Even those who have a negative view of the Affordable Care Act based upon Republican misinformation still prefer to improve it over either repeal or turning to any Republican alternative. As I have written before, Democrats need to go on the offensive on health care reform, not run away from the issue. Joe Conason has the same message again, with numbers now out showing that enrollment through the exchanges has exceeded the projected number of six million:

Success for Obamacare might boost the turnout projections that Republicans have tried so hard to suppress and that Democrats have so far proved unable to resuscitate.

Dominant forces in the Republican Party — including the tea party and its billionaire financiers — have staked everything on the commonplace assumption that Obamacare will drag down Democrats across the country.

Indeed, they make almost no other argument. Bolstering that cynical bet is the Democratic hesitation to mount a powerful counteroffensive on health care, with the impulse to push the minimum wage, unemployment benefits, and other vital issues that still feel safer.

But as Clinton warns, they will find no shelter from this storm. They cannot hide from their own history; and the more they pretend to do so, the more they risk contempt. For decades, Democrats have insisted that all Americans must have health coverage — a momentous and admirable goal advanced by the Affordable Care Act.

With the numbers now on their side, they should lift their heads, raise their voices, and lean into the midterm debate. They have no better choice.

Cross Posted at The Moderate Voice

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Are Many Conservatives Really Liberals?

Liberal or conservative, opposite signs

Polls have generally showed self-identified conservatives outnumbering liberals, with a recent slight increase in the number of liberals. I have often speculated that this is largely due to the success the right wing noise machine has had in demonizing the word liberal. Americans come out more liberal than would be expected by these poll findings when we look at individual issues.

While the pendulum swings both ways, the trend has been toward more liberal policies over the years. Most people wouldn’t think of returning to the days of child labor. Medicare and Social Security are deeply entrenched, to the point that even when Republicans vote for ending Medicare as we know it they realize they have to hide what they are doing. Recent polls show increases in the number of people who support legalization of same-sex marriage and legalization of marijuana. A majority even supports the individual components of Obamacare when asked without identifying the policy as Obamacare.

John Sides reviewed a recent book to argue that many conservatives are really liberals:

In Ideology in America, Christopher Ellis and James Stimson describe a striking disjuncture. When identifying themselves in a word, Americans choose “conservative” far more than “liberal.” In fact they have done so for 70 years, and increasingly so since the early 1960s.

But when it comes to saying what the government should actually do, the public appears more liberal than conservative. Ellis and Stimson gathered 7,000 survey questions dating back to 1956 that asked some variant of whether the government should do more, less, or the same in lots of different policy areas.  On average, liberal responses were more common than conservative responses. This has been true in nearly every year since 1956, even as the relative liberalism of the public has trended up and down.  For decades now there has been a consistent discrepancy between what Ellis and Stimson call symbolic ideology (how we label ourselves) and operational ideology (what we really think about the size of government).

Looked at this way, almost 30 percent of Americans are “consistent liberals” — people who call themselves liberals and have liberal politics.  Only 15 percent are “consistent conservatives” — people who call themselves conservative and have conservative politics.  Nearly 30 percent are people who identify as conservative but actually express liberal views.  The United States appears to be a center-right nation in name only.

This raises the question: why are so many people identifying as conservative while simultaneously preferring more government?  For some conservatives, it is because they associate the label with religion, culture or lifestyle.  In essence, when they identify as “conservative,” they are thinking about conservatism in terms of family structure, raising children, or interpreting the Bible. Conservatism is about their personal lives, not their politics.

But other self-identified conservatives, though, are conservative in terms of neither religion and culture nor the size of government.  These are the truly “conflicted conservatives,” say Ellis and Stimson, who locate their origins in a different factor: how conservatives and liberals have traditionally talked about politics.  Conservatives, they argue, talk about politics in terms of symbols and the general value of “conservatism” — and news coverage, they find, usually frames the label “conservative” in positive terms.  Liberals talk about policy in terms of the goals it will serve — a cleaner environment, a stronger safety net, and so on — which are also good things for many people.  As a result, some people internalize both messages and end up calling themselves conservative but having liberal views on policy.

Ideology has two faces: the labels people choose and the actual content of their beliefs.  For liberals, these are mostly aligned.  For conservatives, they are not.  American conservatism means different things to different people.  For many, what it doesn’t mean is less government.

This idea that nearly 30 percent of self-identified conservative are really liberals would explain the increased support for liberal positions despite a majority identifying themselves as conservatives.

There are some limitations to this, largely due to problems with these labels. It seems to use a simplistic definition of liberals as being for more government and conservatives being for less, but that does not really explain the differences. There are many areas where I am for less government. There is nowhere that I support more government for the sake of more government.

I supported the Affordable Care Act because financing of health care is an area where the market has failed, as insurance companies found it more profitable to find ways to collect increased premiums while finding ways to avoid paying out claims. Conservatives opposed the Affordable Care Act based upon greatly-exaggerated arguments that it is more government (ignoring its similarities to health plans previously advocated by conservatives). Republicans widely supported an individual mandate to buy health insurance until this became part of the plan supported by Barack Obama (who ran against Hillary Clinton opposing the individual mandate). Similarly, conservatives previously supported ideas comparable to the health care exchanges.

On the other hand, conservatives support more big government when it comes to military spending, mandatory vaginal probes, and other intrusions into the private lives of individuals. Even Ron Paul, who voted no on virtually any spending by the federal government, would allow for far greater government restrictions on individual liberties if it came from the state or local level.

Republicans in office generally perform different than their rhetoric would, with big increases in the size of government under Ronald Reagan and George W. Bush. This has been described as being “ideologically conservative, but operationally liberal.” If we just go by their effects on the size of government, Reagan and Bush were the liberals while Barack Obama has been the most conservative president since Dwight Eisenhower. Part of this is because Republican rhetoric is incompatible with actually governing, leading Reagan and Bush to promote far more government spending than would be expected by their rhetoric. Many conservatives realize they didn’t get what they wanted from Bush, but continue to buy the myth of Ronald Reagan as a supporter of small government.

Another problem is a concentration on economic issues and the size of government, as misleading as those issues can be in assigning labels. How would they classify someone who wants to ban abortion, limit access to contraception, opposes same-sex marriage, and supports everyone carrying a concealed weapon, but doesn’t follow the entire Republican line on economic policy? I bet a lot of self-identified conservatives would have no real opposition to a modest tax increase on the wealthy and increasing some government economic regulations (especially if they don’t affect them personally) while holding a number of other conservative positions.

Today many are self-identified conservatives based upon social issues. This didn’t always identify conservatism. Barry Goldwater was a strong opponent of the religious right. He sure called it right in 1994:

Mark my word, if and when these preachers get control of the [Republican] party, and they’re sure trying to do so, it’s going to be a terrible damn problem. Frankly, these people frighten me. Politics and governing demand compromise. But these Christians believe they are acting in the name of God, so they can’t and won’t compromise. I know, I’ve tried to deal with them.

Or maybe they just like being members of the club.  They like to listen to people like Glenn Beck and agree with what they say. However Beck has previously described himself as “a rodeo clown” and conceded, “If you take what I say as gospel, you’re an idiot.”

Cross posted at The Moderate Voice

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The State Of The Democratic Party Today

I found Dan Balz’s article on Democrats in the post-Obama era to be interesting not for any predictions of the future but for the information on the Democratic Party today. I wouldn’t take this as an exact measurement of any views, but a good general approximation.

Balz presented data that the Democratic Party has become more liberal, but with liberals representing a plurality and not a majority. The Democrats remain a big tent party of the left, middle, and center-right while the Republicans have become a predominantly conservative party:

By many measures, the party is certainly seen as more liberal than it once was. For the past 40 years, the American National Election Studies surveys have asked people for their perceptions of the two major parties. The 2012 survey found, for the first time, that a majority of Americans describe the Democratic Party as liberal, with 57 percent using that label. Four years earlier, only 48 percent described the Democrats as liberal.

(In the same survey, 59 percent said they saw the Republicans as conservative, up from 52 percent four years earlier.)

Gallup reported last month that 43 percent of surveyed Democrats identified themselves as liberal, the high water mark for the party on that measurement. In Gallup’s 2000 measures, just 29 percent of Democrats labeled themselves as liberals.

Still, liberals are a plurality of the Democratic Party, not a majority, which is strikingly different from the Republican Party, where Gallup found that 70 percent identified themselves as conservative.

Democrats hold a variety of views, but tend to be more liberal on social issues:

Democrats are most united on cultural and social issues, and it is here where the party has most obviously moved to the left, particularly on same-sex marriage and even the legalization of marijuana. But the party’s shift reflects overall changes in public attitudes that have kept the Democrats within a new political mainstream on these issues.

Women’s issues have provided even more cohesiveness within the party’s coalition.

There is less unity on national security and foreign policy, as much of the party is to the left of Clinton and even of Obama:

On issues of national security and foreign policy, divisions remain. Obama may be president because he opposed the Iraq War and Clinton voted as senator to give then-president George W. Bush the authority to take the country to war. Obama has ended the war in Iraq and is ending the war in Afghanistan, but some progressives are at odds with him over other aspects of his national security policies.

There is also division on economic issues:

On economic issues, the party is torn between two key parts of its coalition.

“One of the biggest failings of the Democratic Party,” Stern said, “is that its funders come from its traditional side of the economic spectrum and its voters come from a more populist, distributive side of the economic agenda.”

Former Montana governor Brian Schweitzer said, “I think the party increasingly is responding to the special interests they need to get elected — the military-industrial complex, big energy, pharmaceutical companies, banks.”

Yet in both policies and tone, there are indications that Democrats have moved to the left. Democratic candidates from all regions — including two potential rising stars running for the Senate in conservative states, Michelle Nunn in Georgia and Alison Lundergan Grimes in Kentucky — have embraced raising the minimum wage. This is a centerpiece of Obama’s agenda heading into this fall’s midterm campaigns…

Hostility to free-trade agreements is still deep among part of the Democratic coalition, but that tension has existed for decades. While many better-educated, upscale voters do not fear the impact of free trade, others, led by organized labor, look at stagnant wages and the difficult job market and attribute those hardships to trade.

Income inequality has received more attention from Democrats but it is based more upon pragmatic economic principles than hostility towards the rich or the egalitarianism falsely attributed to Democrats by many Republicans such as Chris Christie:

Perhaps more than any other economic issue, income inequality has animated progressive activists and voters. Party strategists say this energy is being fueled by lingering fury at Wall Street tycoons, whom they blame for the financial collapse, and deep unease about the nation’s eroding middle class.

“There’s a consciousness developing that’s related to this issue of inequality and the unfairness of our system and the wealth gap that has the potential to really grow and develop into a strong movement that will be reflected in coming elections,” former Ohio governor Ted Strickland said.

William A. Galston of the Brookings Institution said, “It’s not just a case of the very rich getting richer. If that were the only thing going on I think we’d be having a very different conversation. It’s also a case of the people in the middle at best treading water and in fact doing a little bit worse than that.”

Balz’s description of the Democratic Party is consistent with how I have described it in posts here–a big tent with the left more typically liberal on social issues and highly influenced by opposition to the war in Iraq. Democrats have tended to be more pragmatic than ideological on economic issues, with the current economic stagnation exacerbated by the right’s use of government to redistribute wealth to the ultra-wealthy and extreme opposition to government activity even when needed, leading to forces driving both pragmatism and a more populist agenda coinciding.

Looking ahead it is impossible to predict anything at this time other than a victory for Hillary Clinton, but this is based upon her historical position in the party, not whether she is currently representative of where most Democrats stand. If Clinton were to decide not to run, whoever wins the nomination is likely to be quite different from Clinton on the issues.

Cross posted at The Moderate Voice

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Obama And Philosophical Differences Between Left And Right

If viewed from the perspective of perfection, liberals have plenty of reason to object to Obama. There’s his continuation of NSA surveillance, with recommendations for reform which are a good first step but do not go far enough. He continues the disastrous drug war (or should we call it the war against minorities) and is taking far too long to end the war in Afghanistan. He did a fine job of averting the Bush depression upon taking office but his stimulus program was too little (although we must also consider the Republican opposition to this and the manner in which they blocked his other proposals). While the Affordable Care Act has had some major successes, the difficulties in implementation show the advantages of a single-payer plan favored by many on the left. Still, when looking from the perspective of a two-party system, Obama’s accomplishments on economic recovery and health care reform are significant, and there is not a single problem which would not be worse if current Republican policies were being followed. More importantly, there a major difference in world view which can be seen in two recent comments from Obama.

Today there was this statement released on the anniversary of Roe v. Wade:

Today, as we reflect on the 41st anniversary of the Supreme Court decision in Roe v. Wade, we recommit ourselves to the decision’s guiding principle: that every woman should be able to make her own choices about her body and her health.  We reaffirm our steadfast commitment to protecting a woman’s access to safe, affordable health care and her constitutional right to privacy, including the right to reproductive freedom.  And we resolve to reduce the number of unintended pregnancies, support maternal and child health, and continue to build safe and healthy communities for all our children.  Because this is a country where everyone deserves the same freedom and opportunities to fulfill their dreams.

This shows a fundamental difference between Obama, and most Democrats, compared to the majority of Republicans. Republicans have no respect for reproductive freedom, and the right of women to control their own bodies. If you ignore the biology, along with philosophical problems in denying self-ownership of one’s own body, their case against abortion might be somewhat understandable. As it is frequently accompanied by opposition to birth control, it becomes clearer that this is primarily a religious viewpoint which they wish to impose upon others. On a related point, they also desire to impose their religious views to prevent same-sex marriage, an issue which Obama has evolved on. (Plus many Republicans do not even accept basic science with regards to evolution).

Obama showed his views are also evolving on marijuana and the drug war. In an interview with David Remnick in The New Yorker, Obama showed consideration of the underlying issues:

When I asked Obama about another area of shifting public opinion—the legalization of marijuana—he seemed even less eager to evolve with any dispatch and get in front of the issue. “As has been well documented, I smoked pot as a kid, and I view it as a bad habit and a vice, not very different from the cigarettes that I smoked as a young person up through a big chunk of my adult life. I don’t think it is more dangerous than alcohol.”

Is it less dangerous? I asked…

Less dangerous, he said, “in terms of its impact on the individual consumer. It’s not something I encourage, and I’ve told my daughters I think it’s a bad idea, a waste of time, not very healthy.” What clearly does trouble him is the radically disproportionate arrests and incarcerations for marijuana among minorities. “Middle-class kids don’t get locked up for smoking pot, and poor kids do,” he said. “And African-American kids and Latino kids are more likely to be poor and less likely to have the resources and the support to avoid unduly harsh penalties.” But, he said, “we should not be locking up kids or individual users for long stretches of jail time when some of the folks who are writing those laws have probably done the same thing.” Accordingly, he said of the legalization of marijuana in Colorado and Washington that “it’s important for it to go forward because it’s important for society not to have a situation in which a large portion of people have at one time or another broken the law and only a select few get punished.”

As is his habit, he nimbly argued the other side. “Having said all that, those who argue that legalizing marijuana is a panacea and it solves all these social problems I think are probably overstating the case. There is a lot of hair on that policy. And the experiment that’s going to be taking place in Colorado and Washington is going to be, I think, a challenge.” He noted the slippery-slope arguments that might arise. “I also think that, when it comes to harder drugs, the harm done to the user is profound and the social costs are profound. And you do start getting into some difficult line-drawing issues. If marijuana is fully legalized and at some point folks say, Well, we can come up with a negotiated dose of cocaine that we can show is not any more harmful than vodka, are we open to that? If somebody says, We’ve got a finely calibrated dose of meth, it isn’t going to kill you or rot your teeth, are we O.K. with that?”

Far short of ending the drug war, but this leaves open hope of a change in policy. It makes no medical sense for marijuana to be classified as a Schedule I drug, and prohibition causes far more harm than the drug. It is hard to see any leading Republicans, other than perhaps Rand Paul (who does fall short of the libertarian position), considering a change on this issue.

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Majority Support Legalization of Marijuana For The First Time In Gallup Poll

For the first time ever, a clear majority supports legalization of marijuana in a Gallup poll. Currently 58 percent favor legalization and 39 percent are opposed. Not surprisingly, the two groups which most strongly oppose legalization are those over 65 years of age and the Republicans. Once again, the Republicans, despite their rhetoric, remain the party of using big government to intrude upon the private lives of individuals. The polls shows that 65 percent of Democrats, 62 percent of independents, and only 35 percent of Republicans support legalization.

As Gallup pointed out, this parallels the recent increase in support for legalization of gay marriage.

Gallup concluded:

It has been a long path toward majority acceptance of marijuana over the past 44 years, but Americans’ support for legalization accelerated as the new millennium began. This acceptance of a substance that most people might have considered forbidden in the late 1960s and 1970s may be attributed to changing social mores and growing social acceptance. The increasing prevalence of medical marijuana as a socially acceptable way to alleviate symptoms of diseases such as arthritis, and as a way to mitigate side effects of chemotherapy, may have also contributed to Americans’ growing support.

Whatever the reasons for Americans’ greater acceptance of marijuana, it is likely that this momentum will spur further legalization efforts across the United States. Advocates of legalizing marijuana say taxing and regulating the drug could be financially beneficial to states and municipalities nationwide. But detractors such as law enforcement and substance abuse professionals have cited health risks including an increased heart rate, and respiratory and memory problems.

With Americans’ support for legalization quadrupling since 1969, and localities on the East Coast such as Portland, Maine, considering a symbolic referendum to legalize marijuana, it is clear that interest in this drug and these issues will remain elevated in the foreseeable future.

 

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Our New Republican Allies

There was a time before the American conservative movement moved to the extreme right, with denial of any facts which contradicted their extreme views, when some conservatives could be on the right side of some issues. In recent year it has become rare for Republicans to take a position which is grounded in reality or ethically justifiable. Despite their rhetoric, Republicans have run up huge deficits and acted to prevent economic recovery for political gain while pushing for an increased role of government in the private lives of individuals. On foreign policy we saw Republicans push for war with Iraq based upon arguments which can only come from extreme incompetence or blatant dishonesty.

As the Republicans moved to the extreme right there was no choice but to vote Democratic, even if not always agreeing with the Democratic candidates, as even when Democrats compromised principles and moved to the center Republicans offered an even worse alternative. Suddenly the Republicans have become useful in providing votes against war with Syria but I do wish they were taking this position out of higher principles than opposing it because Obama is for it.

While there are exceptions, for the most part the right wing blogosphere remains a cesspool of Obama-hatred, opposing intervention in Syria only because of Obama’s support, and spewing ridiculous claims against Obama even if they are on the right side in this vote. The most absurd arguments from the right include blaming the United States for the use of chemical weapons in Syria. More from Steve M. on this right-wing conspiracy theory.

Beyond various foreign policy disagreements, the biggest disappointments from the Obama administration have been on drug policy. I expected Republicans to be at least as bad, and most likely worse, but maybe not. There was a surprise comment from John McCain at a town hall in Tuscon. While he took the expected ultra-hawkish view on Syria, he also suggested that maybe marijuana should be legalized: “Maybe we should legalize. We’re certainly moving that way as far as marijuana is concerned. I respect the will of the people.”

Of course there is a huge difference between a comment thrown out such as this and actually taking action, but it is a sign of how attitudes towards prohibition are changing that McCain would feel comfortable raising this idea before his constituents.

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Positive News In The Culture War on Equal Rights For Gay Couples and Marijuana Laws

There was some good news today which should upset quite a few social conservatives.

The Department of Treasury announced today that same-sex marriages will be treated as any other marriages nation-wide in response to the Supreme Court invalidating the Defense of Marriage Act:

The U.S. Department of the Treasury and the Internal Revenue Service (IRS) today ruled that same-sex couples, legally married in jurisdictions that recognize their marriages, will be treated as married for federal tax purposes. The ruling applies regardless of whether the couple lives in a jurisdiction that recognizes same-sex marriage or a jurisdiction that does not recognize same-sex marriage.

The Department of Health and Human Services also revised rules in response to the Supreme Court decision:

Today, the Department of Health and Human Services (HHS) issued a memo clarifying that all beneficiaries in private Medicare plans have access to equal coverage when it comes to care in a nursing home where their spouse lives.  This is the first guidance issued by HHS in response to the recent Supreme Court ruling, which held section 3 of the Defense of Marriage Act unconstitutional.

“HHS is working swiftly to implement the Supreme Court’s decision and maximize federal recognition of same-sex spouses in HHS programs,” said HHS Secretary Kathleen Sebelius.  “Today’s announcement is the first of many steps that we will be taking over the coming months to clarify the effects of the Supreme Court’s decision and to ensure that gay and lesbian married couples are treated equally under the law.”

“Today, Medicare is ensuring that all beneficiaries will have equal access to coverage in a nursing home where their spouse lives, regardless of their sexual orientation,” said Centers for Medicare & Medicaid Services (CMS) Administrator Marilyn Tavenner.  “Prior to this, a beneficiary in a same-sex marriage enrolled in a Medicare Advantage plan did not have equal access to such coverage and, as a result, could have faced time away from his or her spouse or higher costs because of the way that marriage was defined for this purpose.”

Under current law, Medicare beneficiaries enrolled in a Medicare Advantage plan are entitled to care in, among certain other skilled nursing facilities (SNFs), the SNF where their spouse resides (assuming that they have met the conditions for SNF coverage in the first place, and the SNF has agreed to the payment amounts and other terms that apply to a plan network SNF).  Seniors with Medicare Advantage previously may have faced the choice of receiving coverage in a nursing home away from their same-sex spouse, or dis-enrolling from the Medicare Advantage plan which would have meant paying more out-of-pocket for care in the same nursing home as their same-sex spouse.

Today’s guidance clarifies that this guarantee of coverage applies equally to all married couples.  The guidance specifically clarifies that this guarantee of coverage applies equally to couples who are in a legally recognized same-sex marriage, regardless of where they live.

The Department of Justice announced it will not challenge state marijuana laws legalizing marijuana:

Today, the U.S. Department of Justice announced an update to its federal marijuana enforcement policy in light of recent state ballot initiatives that legalize, under state law, the possession of small amounts of marijuana and provide for the regulation of marijuana production, processing, and sale.

In a new memorandum outlining the policy, the Department makes clear that marijuana remains an illegal drug under the Controlled Substances Act and that federal prosecutors will continue to aggressively enforce this statute. To this end, the Department identifies eight (8) enforcement areas that federal prosecutors should prioritize.  These are the same enforcement priorities that have traditionally driven the Department’s efforts in this area.

Outside of these enforcement priorities, however, the federal government has traditionally relied on state and local authorizes to address marijuana activity through enforcement of their own narcotics laws. This guidance continues that policy.

For states such as Colorado and Washington that have enacted laws to authorize the production, distribution and possession of marijuana, the Department expects these states to establish strict regulatory schemes that protect the eight federal interests identified in the Department’s guidance. These schemes must be tough in practice, not just on paper, and include strong, state-based enforcement efforts, backed by adequate funding. Based on assurances that those states will impose an appropriately strict regulatory system, the Department has informed the governors of both states that it is deferring its right to challenge their legalization laws at this time.  But if any of the stated harms do materialize—either despite a strict regulatory scheme or because of the lack of one—federal prosecutors will act aggressively to bring individual prosecutions focused on federal enforcement priorities and the Department may challenge the regulatory scheme themselves in these states.

The ruling is mixed. Tom Angell, Chairman of Marijuana Majority, sent out this response by email earlier today:

“It’s nice to hear that the Obama administration doesn’t at this point intend to file a lawsuit to overturn the will of the voters in states that have opted to modernize their marijuana policies, but it remains to be seen how individual U.S. attorneys will interpret the new guidance and whether they will continue their efforts to close down marijuana businesses that are operating in accordance with state law.

“It’s significant that U.S. attorneys will no longer be able to use the size or profitability of a legal marijuana business to determine whether or not it should be a target for prosecution, but the guidelines seem to leave some leeway for the feds to continue making it hard for state-legal marijuana providers to do business.

“The administration’s statement that it doesn’t think busting individual users should be a priority remains meaningless, as it has never been a federal focus to go after people just for using small amounts of marijuana. The real question is whether the president will call off his federal agencies that have been on the attack and finally let legal marijuana businesses operate without harassment, or if he wants the DEA and prosecutors to keep intervening as they have throughout his presidency and thus continue forcing users to buy marijuana on the illegal market where much of the profits go to violent drug cartels and gangs.

“In all, today’s announcement represents a step in a right direction and a recognition by the administration that the politics of marijuana are rapidly shifting in favor of those who support legalization. However, my optimism is tempered by the fact that despite the Justice Department’s 2009 announcement that it shouldn’t be a priority to bust medical marijuana providers operating in accordance with state law, this administration went on to close down more state-legal marijuana businesses in one term than the Bush administration did in two terms.

“Polls from Pew and Gallup show that a supermajority of Americans wants the president to follow through on his 2008 pledges to respect marijuana laws, and that’s what advocates will continue pressing him to do.”

Also today, a federal appeals Court upheld California’s ban on “conversion therapy” which attempts to turn gay individuals straight.

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Eric Holder Deescalates The Drug War

Changes in government policy often occur far too slowly. One of the reasons I supported Obama for the Democratic nomination in 2008 was suggestions that he might be willing to pull back on the drug war, as well as ending the war in Iraq. The first term was very disappointing with regards to drug policy. Today we finally saw signs that, while far less than I would like to see, the Obama administration is moving in the right direction. From The New York Times:

In a major shift in criminal justice policy, the Obama administration moved on Monday to ease overcrowding in federal prisons by ordering prosecutors to omit listing quantities of illegal substances in indictments for low-level drug cases, sidestepping federal laws that impose strict mandatory minimum sentences for drug-related offenses.

Attorney General Eric H. Holder Jr., in a speech at the American Bar Association’s annual meeting in San Francisco on Monday, announced the new policy as one of several steps intended to curb soaring taxpayer spending on prisons and help correct what he regards as unfairness in the justice system, according to his prepared remarks.

Saying that “too many Americans go to too many prisons for far too long and for no good law enforcement reason,” Mr. Holder justified his policy push in both moral and economic terms.

“Although incarceration has a role to play in our justice system, widespread incarceration at the federal, state and local levels is both ineffective and unsustainable,” Mr. Holder’s speech said. “It imposes a significant economic burden — totaling $80 billion in 2010 alone — and it comes with human and moral costs that are impossible to calculate.”

This is a long way from what I would like to see, but much closer to what I thought might plausible occur under Obama. Hopefully this will be followed by an end to the raids of medical marijuana facilities, and ideally a move towards either decriminalization or legalization. There is hope that a coalition between Democrats and libertarian-leaning Republicans might also bring about long term legislative change, which is preferable over a decision from one administration to selectively avoid longer sentences. It is even the fiscally responsible thing to do.

We have seen how quickly the attitude towards restrictions on marriage equality is changing. Attitudes on drug laws might be the next to change.

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Majority Supports Legalization of Marijuana

We’ve seen it with same-sex marriage, and now we are seeing the same phenomenon with legalization of marijuana The United States, while still suffering from a strong and dangerous conservative movement, in general is rapidly becoming more liberal on social issues. The Pew Research Center found that a majority support legalization of marijuana:

For the first time in more than four decades of polling on the issue, a majority of Americans favor legalizing the use of marijuana. A national survey finds that 52% say that the use of marijuana should be made legal while 45% say it should not.

Support for legalizing marijuana has risen 11 points since 2010. The change is even more dramatic since the late 1960s. A 1969 Gallup survey found that just 12% favored legalizing marijuana use, while 84% were opposed.

Not surprisingly, liberal Democrats are far more likely than conservative Republicans to support legalization:

Only about three-in-ten conservative Republicans (29%) say marijuana use should be legal. Moderate and liberal Republicans are far more likely than conservatives to favor legalization (53%).

Like Republicans, Democrats are ideologically divided over legalizing marijuana. While 73% of liberal Democrats favor legalizing use of marijuana, only about half of conservative and moderate Democrats agree (52%).

Despite these partisan differences, both parties have similar views on enforcement of marijuana laws:

There are partisan differences over legalizing marijuana use and whether smoking marijuana is morally wrong. But Republicans and Democrats have similar views on enforcing marijuana laws: 57% of Republicans and 59% of Democrats say that the federal government should not enforce federal marijuana laws in states that permit its use. Substantial majorities of both Republicans (67%) and Democrats (71%) also say federal enforcement of marijuana laws is not worth the cost.

I wonder if many Republicans are looking at this from a states’ rights point of view. They also might be viewing this as fiscal conservatives, realizing that prohibition does not work and therefore not worth spending money on.

Perhaps this will also lead to decreased overall support for the drug war, and support for  allocating more resources towards addressing the underlying problems contributing to drug addiction and abuse as opposed to perpetuating the drug war.

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