The split among states, Biden's Medicare proposal, Alaska politics & more notes

My weekly roundup

Oklahoma’s overwhelming rejection of legal recreational marijuana sales was the latest reminder (along with Florida Gov. Ron DeSantis’s agenda for the new legislative session, and the fight over Walgreens providing abortion drugs) that the differences in policies between red states and blue states are going to grow starker in the coming years.

The idea of national divorce proposed by Rep. Marjorie Taylor Greene is totally preposterous — especially since most of our divisions are actually intrastate, not interstate, pitting urban and suburban people against rural and exurban ones.

But on a full range of issues, from marijuana legalization, to guns, to abortion, to LGBTQ rights, to what teachers and professors can cover in classrooms, we’re going to see massive differences between red states and blue states, based on which side of our political divide (urban/suburban or rural/exurban) wields power.

To some extent, this is a byproduct of a gridlocked federal government not setting national policy. In our deeply polarized times, the Senate’s filibuster makes it exceedingly difficult to legislate on these hot button cultural topics in anything more than a narrow way. It’s also driven by fear that the opposition is attacking rights and values that voters see as fundamental and essential. With constituents afraid, politicians recognize the opportunity to gain national prominence (very rare is the politician who looks in the mirror and doesn’t see presidential material) by innovating in these areas — being the first to enact new protections or restrictions. That then creates a cascade effect as other ambitious politicians on that side rush to replicate these initiatives or take them even further.

DeSantis’s culture wars initiatives and rhetoric are a great example of this. Just look at some headlines and subheads (known as decks in journalism): “GOP lawmakers follow Florida’s lead with DeSantis copycat bills,” “A Tale of 3 Governors: The Republican governors of Florida, Texas and Virginia are drastically reshaping higher education in their states—which some see as a precursor to the 2024 presidential race,” “Ron DeSantis Solidifies 2024 Stance as Republicans Follow Florida's Lead,” and “As 2024 nears, Florida Gov. Ron DeSantis looms large over Gov. Greg Abbott in Texas.”

The Walgreens situation exposes how this broader state of play — in which states rush to opposite poles on scores of issues — has major ramifications of all kinds. The company is caught between conservative politicians threatening legal consequences if it dispenses abortion pills in their states and California Gov. Gavin Newsom, who cut the company off from state business in the largest state in America for caving to the conservatives.

And that’s the tip of the iceberg — from people running afoul of laws in adjacent states with wildly different policies on things like guns and marijuana use to potential teacher shortages, it’s easy to dream up a significant raft of consequences as politicians push the limits of what is legal and possible.

This trend might precipitate a mutually reinforcing cycle too. As laws gets more liberal or more conservative in a place, the more tempting it will become for people to move to places whose policies reflect their values. It will be fascinating to see what happens in major cities in red states and rural areas in blue ones in this regard…

Alaska’s bipartisan congressional delegation made a plea to President Biden this week to approve the “Willow Project,” a ConocoPhillips drilling project that they say will provide enormous benefits. Biden’s environmentalist base probably will oppose this, but he should seriously consider green lighting the project. Why? Political opportunity.

Alaska has long been a Republican state, but as Rep. Mary Peltola’s victory in a special election and reelection in 2022 illustrated, Democrats have been making and can make real inroads in the state. Consider: in 2004, George W. Bush won Alaska by 25.5 points. By 2020, Donald Trump won it by only 10. Alaska politics have always been quirky, but it has long seemed as though the biggest obstacle for Democrats contending in the state has been the perception that they oppose oil drilling, which is a backbone of the state’s economy. I’m sure being the anti-gun party also doesn’t help.

But the declining margin in presidential contests indicates that Alaska may be competitive by 2028 or 2032. And while it’s a small state, which may matter less at the presidential level, Democrats need places (and I know I say this regularly) where they have a shot at Senate seats. So long as every state gets two senators — and that’s not changing — Democrats need to become competitive in more places. Given that Alaska now has ranked choice voting, which advantages moderate candidates, it’s a place of possibility that may not be off the table. Peltola, especially, looks like a promising young politician (yes, 49 is young in politics) — the kind who might land in the Senate at some point.

But to be really competitive in Alaska, Democrats probably need to chip away at the perception that they are inextricably opposed to the fossil fuel development so critical to the state’s economy. The Willow Project may offer an opportunity to do that — while also currying favor with two Republican senators who can be critical votes in the Senate, where Biden needs 60 votes to enact any of his priorities…

Biden offered a proposal this week to extend the solvency of Medicare beyond 2050. His plan to increase taxes on the wealthy (a must to save both Social Security and Medicare without cutting benefits), and to further attempt to drive down the costs of prescription drugs makes sense. But here’s the sobering reality: in 2021, Americans spent $378 billion on prescription drugs. That pales in comparison to the $1,323.9 billion spent on hospital expenditures (I don’t know why it’s not represented as $1.323 trillion) and $864 billion spent on physician and clinical services.

These numbers reveal that if we’re going to address the drivers of the constant increase in healthcare spending — which hurts Americans, increases health insurance rates, and pushes up the costs of Medicare and Medicaid — we need to focus on cutting how much we spend on hospital costs and physician services as well as on prescription drugs. We’ve all seen those nightmarishly large hospital bills — some of them so high they're absurd. You’d need to be Jeff Bezos to pay them off. And while health insurers negotiate those bills down for those with coverage, it reflects how crazily high costs are for everything from routine blood tests to diagnostic scans (Don’t believe me? Check and see what your insurance company pays the next time you get a test done).

For decades, hospitals and physicians have warned that limiting their ability to charge what they want will stifle innovation, risk shortages, and catalyze a broader parade of horribles. But to really, truly address the medical cost problem, specialists need to see their rates drop, we need to rethink the fee for service medical system that incentivizes procedures — not primary care and preventative measures — and we need to do with hospital costs what Biden is trying to do with prescription drug prices.

Absent that, Medicare will continue to have solvency issues, Medicaid spending will continue to increase, private insurance rates will keep rising, and medical bills will continue to be a real hardship for millions of Americans…

Watch media coverage of Biden’s budget proposal. As I pointed out on Twitter, The New York Times article detailing some of the proposals ran under the headline, "Biden’s $6.8 Trillion Budget Proposes New Social Programs and Higher Taxes.” While I try to avoid criticizing headline writers, because I write headlines myself and it’s brutally hard to create something that will catch readers’ attention, please aggregators’ algorithms and keep the character count down — all without distorting the piece.

Brian Rosenwald @brianros1

Rarely do I criticize headlines. I write them, & it's really hard. But the Times has: "Biden’s $6.8 Trillion Budget Proposes New Social Programs and Higher Taxes." If you're going to say Higher Taxes, you have to include "for the wealthy." Otherwise it's politically incendiary

But framing matters a lot in politics — in this case it may determine how the proposals play politically. Biden is proposing 0 tax increases for those making less than $400k. The budget proposal focuses on taxing investment income more fairly, payroll tax increases for the wealthy, closing loopholes, and raising the corporate tax rate. If voters come to perceive Biden as wanting to raise taxes on the wealthy to address the deficit and make the system fairer, that probably plays in his favor. But if they see him as wanting to hike their taxes, that will hurt.

A headline like the Times one conveys to readers that Biden wants to raise all taxes or taxes on all Americans. But that’s not true. This is a case where sacrificing character count limits to add the words “for the wealthy” would have made the headline far clearer. Journalists need to think about such things when synthesizing the content of a story risks distorting meaning like this. Ideally, people would read the entire story, but that’s not how it works in our world with incredibly limited attention spans…

We’re less than 2 weeks from the 20th anniversary of the Iraq War. And we have a wonderful new book to help us reassess the decisions behind it and the war’s consequences: Mel Leffler’s Confronting Saddam Hussein. In addition to being one of my mentors — really the person I credit with dramatically improving my writing — Leffler is probably America’s preeminent historian of the Cold War.

The book has faced nonsense criticism on social media because Leffler interviewed many of the principles from the Bush Administration and a few people concluded he got taken in by them — probably without reading the book. That’s false. The book is a searing takedown of the flawed decision making that led to a disaster in Iraq — most especially the lack of consideration of the potential risks of going to war and the lack of planning and thought given to what would come after toppling Hussein. It does, however, also demolish a bunch of myths on the left about the motives of President Bush and other key policymakers.

Leffler demonstrates that they were well intentioned, motivated by fear of another terrorist attack, especially one using weapons of mass destruction, shame that they had ignored warnings before 9/11, hubris after the relatively quick toppling of the Taliban (which, of course, we now know proved only temporary), and by the reality that no one believed Hussein would give up the biological and chemical weapons that most policymakers and intelligence operatives thought he had without a real, genuine threat of force. Bush and his team weren’t trying to settle old scores, remake the world into some sort of Wilsonian utopia, nor did they have any designs on going to war in Iraq before 9/11. Bush genuinely wanted to avoid war — and certainly didn’t decide to give the green light to military action before early 2003. He didn’t believe Hussein had nuclear weapons or any ties to Al Qaeda. He tried to practice coercive diplomacy, until it seemed to fail. Then he invaded, believing the risk of Hussein having biological and chemical weapons and the potential damage to American credibility from not following through on his threat would be too great not to act.

But anyone who thinks the book is soft on Bush and his team hasn’t read it.

One thing that the book reinforced for me, which has broad ramifications beyond foreign policy: selecting a president’s team is crucial. Even in this era when cabinet secretaries wield far less influence and power than they did in earlier times, they can undermine a president’s policy, ensure its success or failure, and really shape outcomes on crucially important matters.

If there is one person in Leffler’s account who deserves the most scorn and blame, it’s the crusty Defense Secretary Donald Rumsfeld, selected to placate conservatives worried about Colin Powell’s star power. The brusque Rumsfeld alienated leading generals and other members of Bush’s team, which stifled debate and poisoned cooperation among the National Security Council, the State Department, and the Defense Department. He also had 0 interest in considering what would happen after the U.S. toppled Hussein — despite Bush assigning DOD with the responsibility of overseeing post-war planning. His insistence on sending fewer troops to Iraq and then getting them out more quickly also contributed to crumbling security conditions that led to disaster.

Reading Leffler’s account, it’s truly astounding it took until 2006 for Bush to demand Rumsfeld’s resignation. Truthfully, he was the wrong man at the wrong time, and one wonders how things might have been different had Bush recognized that reality even before 9/11.

The case of Rumsfeld illustrates how while everything from diversity to political considerations and confirmability matters in the selection of a cabinet, the top factor for presidents when selecting White House staff (who, of course, don’t need confirmation) and cabinet secretaries should be: do they believe in the president’s agenda and do they have the personal skills to manage a large bureaucracy and be part of a team?

If the answer is no — as it was for Rumsfeld on the latter count — nothing else should matter…

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