Tough Choices

In her latest Wall Street Journal column, Peggy Noonan reflects on the challenges currently facing the Trump administration and lays out an interesting scenario:

2008 and the years just after (the crash and the weak recovery)...changed everything in America, and...the country [is] going to choose, in coming decades, one of two paths—a moderate populism or socialism—and...the former [is] vastly to be preferred, for reasons of the nation’s health. A gifted politician could make his party the leader toward that path, which includes being supportive and encouraging of business but willing to harness government to alleviate the distress of the abandoned working class and the anxious middle class; strong on defense but neither aggressive nor dreamy in world affairs; realistic and nonradical on social issues while unmistakably committed to protecting the freedoms of the greatest cohering force in America, its churches; and aware that our nation’s immigration reality was a scandal created by both parties, and must be redressed.

I'm not sure that "moderate populism" or socialism are the only two choices on the political menu in the years ahead.  But it does seem that, if you want to check the risk of a shift toward more radically socialistic policies, you have good reason to address some of the forces driving the populist insurgency.  Strained social networks, economic decline, identity politics, etc.--all these challenge the future of limited government in the United States.

Furthermore, due to the nature of the two-party system, there is a very real risk that the failure of a populist-conservative alliance will not lead to the return of Conservatism (TM), newly purified.  Instead, it could empower an aggressive and aggrieved "progressivism."

Many of the policy points that Noonan suggests for this "moderate populism" could indeed by part of a potentially successful governing vision.  We'll have to see if the GOP will try to implement it.

Manchin, Heitkamp Back Gorsuch

Democratic senators Joe Manchin (W.V.) and Heidi Heitkamp (N.D.) have come out in support of Neil Gorsuch's nomination to the Supreme Court.  Both offered praise of the nominee.

As Senator Heitkamp said in a statement, Gorsuch "has a record as a balanced, meticulous, and well respected jurist who understands the rule of law."

Senator Manchin was even more effusive:

During his time on the bench Judge Gorsuch has received praise from his colleagues who have been appointed by both Democrats and Republicans. He has been consistently rated as a well-qualified jurist, the highest rating a jurist can receive, and I have found him to be an honest and thoughtful man. I hold no illusions that I will agree with every decision Judge Gorsuch may issue in the future, but I have not found any reasons why this jurist should not be a Supreme Court Justice.

Some Senate Democrats have argued that Gorsuch is wildly out of the mainstream or somehow suspect.  But their colleagues from West Virginia and North Dakota don't seem to agree.

More Gorsuch Vote-Grubbing

Today, a number of Democratic senators thought to be swing votes on a Gorsuch filibuster came out against him.  Jeanne Shaheen (N.H), Maggie Hassan (N.H), and Amy Klobuchar (Minn.) all have announced their support for the latest talking point: a "60-vote threshold."  As Senator Shaheen's press release reads:

As Judge Gorsuch’s nomination comes to the floor, I will support a 60-vote threshold for approval, an appropriate high bar that has been met by seven of the eight current Supreme Court justices.

In fact, 6 of the current 8 Supreme Court justices were confirmed with fewer than 60 votes (Alito and Thomas), so 25 percent of the Supreme Court was approved with fewer than 60 votes.

In addition to being novel, the "60-vote threshold" is a bit ambiguous.  What does it even mean to support a 60-vote threshold?  Does it mean that one thinks a Supreme Court justice should ideally have 60 votes to be confirmed but that one won't do that much to stop the nomination of a justice who doesn't pass that threshold?  Or does it mean that one will not vote for cloture on this nomination and thereby keep that nominee from having an up-or-down vote?

I've reached out to the offices of Senators Shaheen, Hassan, and Klobuchar to ask them whether they will indeed vote against cloture and so far have not heard back from any of them.  This "60-vote threshold" could be mere messaging (in order to obscure the fact that these senators intend to block an up-or-down vote on Gorsuch), or it could be part of an effort to give themselves some maneuvering room.  (Incidentally, I wondered last night if Shaheen and Hassan would move as a pair on Gorsuch, and it seems as though they did.)

It seems as though there are still enough Democrats out there who have not announced their position on Gorsuch that he could still overcome a filibuster.  I draw your attention to this passage from Politico:

The five Democratic senators up for reelection next year in states where President Donald Trump won by single digits have all endorsed a filibuster of Gorsuch, while the five facing voters next year in states Trump won by double digits all remain undecided. Gorsuch would have to carry all five of those fence-sitters to overcome a Democratic filibuster — plus his home-state Sen. Michael Bennet (D-Colo.), Maine independent Sen. Angus King, and another more surprising senator.

Senators Tester, McCaskill, Heitkamp, and Donnelly have not ruled out supporting cloture.  Delware's Chris Coons seems pretty wary of a nuclear stand-off, and Pat Leahy still seems open to voting for cloture.

Thus, the success of a partisan filibuster against Gorsuch is not yet guaranteed--at least according to public accounts.  (My guess is that some Democrats might hold off on announcing whether or not they will vote for cloture on Gorsuch for a little while.)

Some parting thoughts via Jason Willick:

A successful filibuster of Gorsuch would set a different precedent altogether: Namely, that a President can’t fill a Supreme Court vacancy even with a thoroughly mainstream nominee unless his party controls a 60-seat Senate supermajority. In other words, that new justices can only be seated during truly anomalous periods of one-party dominance that sometimes don’t come around for decades. Needless to say, this scenario is impossible to sanction: the Court would wither and its credibility would crumble.

Unwanted Advice

Tilting at windmills is one of my favorite hobbies, so I just can't keep myself from commenting on Democratic plans to filibuster Neil Gorsuch.  Sustaining a filibuster against Gorsuch would, of course, be tactically futile and strategically counterproductive for Democrats.  While rallying the "progressive" base, it would ultimately not stop Gorsuch's ascension to the Supreme Court; many Republican senators seem to be making the (not unreasonable calculation) that, if Democrats will filibuster the Gorsuch nominee, they'll filibuster any Trump nominee who is not David Souter II.  Moreover, the detonation of the "nuclear option" against this filibuster would destroy the (slight but still perceptible) leverage the minority party in the Senate has over a Supreme Court nominee.  Proponents of stacking the Supreme Court with right-leaning ideologues would not doubt celebrate this futile effort by Democrats, but a sustained Gorsuch filibuster might worry those who think that the Senate should protect the voice of the minority and the prerogatives of individual senators.

It seems as though at least a few Senate Democrats are aware of the fact that indulging in the calls of the "resistance" to sustain a filibuster against Gorsuch would mean actually weakening the powers of Senate Democrats.  There are reasons why Pat Leahy, a staunch leftist, is hesitant about filibustering Gorsuch.  He knows the political costs and the damage this could do to the Senate's culture.  It would further politicize the nomination process and further polarize the chamber.  In this divided time, it would seem important to protect the institutions of compromise and moderation, and the filibuster might be one of those institutions.

But how could Democrats not goad the GOP into nuking the filibuster while also not suffering too much of a backlash from the "resistance"?

Allahpundit has suggested that Leahy's announcement could be part of an effort by Senate Democrats to thread that needle:

A filibuster now would be the purest strategic idiocy and Schumer knows it. Solution, then: Endorse the filibuster in his role as minority leader while nudging Leahy, a Senate institution and Judiciary Committee veteran who almost certainly can’t be defeated in Vermont, to lead the rebellion instead. Now, when Manchin and Bennet and McCaskill et al. need to justify their votes in favor of cloture, they can point to Leahy and say, “Sen. Leahy’s judgment carries such heavy weight with me, especially in terms of getting politics out of judicial nominations, that I feel obliged to join him in this vote.” Leahy then becomes the lightning rod. But so what? He’s immune from this sort of political lightning. He’ll be just fine, and so will all of the red-state Dems who vote for cloture along with him once the left realizes that they’re in no positional electorally to further weaken their chances in 2018 by primarying any of them over their Gorsuch votes.

One could extend this strategy: A coalition of far-left Democrats from safe seats and Democrats who are up for reelection in lean-Republican states could vote for cloture on Gorsuch. The first set could have enough "progressive" credentials to ward off a primary challenge, and the second could be protected by the demands of electability.

According to CNN, two Democrats have already said they will vote for cloture on Gorsuch: Joe Manchin and Heidi Heitkamp (more or less).  That means 6 more will have to vote for cloture to break a Gorsuch filibuster.  Could those 6 votes be found?  Quite possibly.

If Democrats are worried about primary challenges, it would make the most sense to have senators reelected in 2016 vote for cloture on Gorsuch.  They have almost 6 years before they have to face voters.  Senator Leahy was reelected in 2016.  Michael Bennet, from Gorsuch's home state of Colorado, was also reelected in 2016 and has also been noncommittal about whether he will filibuster Gorsuch.  New Hampshire's Maggie Hassan is new to the Senate.  But she has a solid Democratic infrastructure in the Granite State (which could help her with primary challenges), and New Hampshire is a swing state.  Senator Hassan's fellow New Hampshire Democrat Jeanne Shaheen has sent mixed messages on a Gorsuch filibuster, stating that he kinda sorta deserves an "up-or-down vote."  Perhaps she and Hassan will vote as a block either for or against cloture.  Chris Coons, a solid lefty from Delaware, was reelected in 2014 and has warned about the risks of filibustering Gorsuch. Minnesota's Amy Klobuchar is rumored to be a swing vote on cloture; up for reelection in 2018, she represents a state (Minnesota) that Trump almost won in 2016.

That's 6 votes possible on the left right there.

There are also senators from swing states or lean-Republican states who have not yet expressed a position on cloture for Gorsuch: Angus King (I-Maine), Missouri's Claire McCaskill (who said she opposed the Alito filibuster), Joe Donnelly (Ind.), and Jon Tester (Mont.).

It seems possible that a center-left coalition could vote for cloture on Gorsuch with minimal risk of political backlash.  That outcome would probably be in the best interests of the Senate and of Democrats over the long term.

However, it's also possible that the Democratic caucus could hold hands and take the plunge on sustaining a filibuster against Gorsuch.  In an era when indulging the id has increasingly become a political priority, this outcome would not be at all surprising. But it still would be somewhat dismal.

RIP Linda Bridges

Linda Bridges died on Saturday night.  She was an institution at National Review.  Here are a couple paragraphs from her obituary that give a sketch of her relationship with NR:

While a junior in college, she dared write to National Review to point out and quibble with what she considered to be a grammatical error that had been used repeatedly in the magazine. Her letter intrigued none other than William F. Buckley himself, who responded to her letter, requesting that she send additional samples of her writing. She did, and was offered a position as a summer assistant. He so approved of her style, her extensive vocabulary and inveterate skill at word-smithing, and her content (Linda was a life-long conservative) that he quickly offered her a job at the magazine upon her graduation. And the rest, as they say, is history.

Linda moved to New York City immediately upon graduation from USC, and entered the employ of National Review as a contributing writer/journalist. Over the years, she rose through the ranks to Senior Editor, and finally to Editor-at-Large at the magazine. She also served as a personal editor for her mentor and father-figure, William F. Buckley, from 2004 until his death in 2008, organizing and preparing for publication his many writings and memoirs. Among the books she authored over the years were The Art of Persuasion: A National Review Rhetoric for Writers; Strictly Right: William F. Buckley and the American Conservative Movement; and Athwart History: Half a Century of Polemics, Animadversions, and Illuminations — A William F. Buckley Jr. Omnibus.

Read the rest to learn even more about the adventure that was her life.

I didn't know Linda very well, but I was lucky enough to have her edit some of my pieces for NRO over the years.  She edited my very first piece for NRO, and some of my favorites, including pieces on enlightened populism, the limitations of Herbert Marcuse, the importance of defending liberty and union, and how to create an opportunity-oriented immigration system.

With an almost Houdini-like ability to get the knots out of prose, Linda had a wonderful ear for language and an amazing empathy as an editor.  She treated your work respectfully, and part of that respect was trying to help you make your points as eloquently as possible.  Her love of words shone through in her work.  I was--and am--grateful for her own efforts to improve my work.

Because Linda was a writer as well as an editor, I thought I'd include a link here to the last piece she wrote for NRO, a substantive reflection on World War I, C.S. Lewis, and J.R.R. Tolkien.

Linda's faith was incredibly important to her, and I hope that she knows the comfort of the Lord who watches over us all.

After the End

At National Review, I have some thoughts about the failure of the vote on the American Health Care Act:

The death of the American Health Care Act has been greatly exaggerated — not because it is likely to be revived (at least in its current form) but because it might never have really been alive in the first place.

Many of the provisions of the bill were unlikely to survive contact with the Senate, and there was a very strong chance that the bill that was released from a House–Senate conference would radically differ from the AHCA. Perhaps realizing the limits of the AHCA, some defenders of the AHCA supported the measure principally as a way of getting to conference. However, there is no reason to believe that the tensions that pulled down the AHCA on Friday would not similarly undo the resulting House–Senate conference bill. Some Republicans would still be upset that the conference bill was not a full repeal of the Affordable Care Act, and moderates (along with some populists) would be pulled into a tug-of-war with budget-cutters over the size of Medicaid cuts.

You can read the rest over there, but I'll make a few general points here.

This is not necessarily a CATACLYSMIC DEFEAT for President Trump or congressional Republicans.  The real political risks of the bill had it passed (such as cuts to health-care subsidies for the working class) in part explain why it failed to pass the House.  The defeat of the bill gives Republicans a chance to start health-care reform over again or to turn to other issues.

That said, the debate over the AHCA did highlight real divides within the Republican coalition.  Some of these divides (such as populists v. budget-cutters) will have to be at least partially overcome if Republicans hope to pass major pieces of legislation.  Two important words will be compromise and imagination.

If there is to be another Republican effort at health-care reform, policymakers might find it wise to prioritize reforms to help drive down the cost of health care through making the medical system more nimble and responsive to consumers.

Some other interesting responses to the fall of the AHCA: Reihan Salam says that we shouldn't blame the Freedom Caucus for the AHCA's failure.  Pascal-Emmanuel Gobry recommends the following course of action for conservatives on health care:"Slash regulations. And then subsidize health care."   Tim Alberta narrates the fall of the AHCA.  Ben Domenech thinks that congressional leaders need to embrace transparency in the crafting of legislation.

Battle over the AHCA

In NRO, I look at the possibility of the American Health Care Act (which is supposed to be voted on Friday) exacerbating tensions between conservatives and populists:

While it achieves many longstanding priorities for Beltway Republicans, [the AHCA] contains some provisions that could alienate members of the working class, such as Medicaid cuts. It is telling that elements of the Right who have been very sympathetic to populist themes — such as Ann Coulter, many Breitbart writers, and Arkansas senator Tom Cotton — have been unsparing in their criticism of the AHCA. The bill itself is currently extremely unpopular, supported by only 17 percent of Americans according to the latest numbers from Quinnipiac.

It might be especially divisive for the Republican coalition. Donald Trump’s presidential campaign was premised upon outreach to working-class voters, and an improved performance with this demographic was crucial for breaking the “blue wall” at the presidential level and for the GOP’s successful defense of its Senate majority.

You can read the rest over there.

Things are so fluid with the AHCA that I'll defer making any predictions.  Instead, a few random observations.

If the AHCA does pass tomorrow, President Trump's decision to say that he'll stop negotiating tonight (pass the current bill, or I'll move on) could make him look like he's someone who knows how to work his will on Congress.  So it could foster an image of him being a "strong leader."  Of course, the AHCA passing also means that House Republicans will have signed on to a less-than-popular bill, one with real potential to divide the GOP coalition.  It also means that President Trump will get either the credit or the blame for this bill.  It's also hard to see what happens in the Senate in taking up the AHCA; it's very possible that the things that made this bill pass the House will make it very hard for it to pass the Senate.

If the AHCA fails, the White House and Republicans may be free to move on to other policies, ones that might be more popular.  Michael Brendan Dougherty, for instance, has suggested that the GOP consider some of the policy areas that were at the center of the Trump campaign, such as infrastructure, trade, and immigration.  They might also be able to take on healthcare in a way that circumvents some of the tensions heightened by the AHCA (see my NRO post for more thoughts on that).  The failure of the AHCA might cause a few negative newscycles ("Republicans in disarray!!!1"), but it's unclear whether a defeat tomorrow will have a lasting effect on the GOP agenda.

The GOP runs grave political risks if it does not attempt to promote policies that deliver for the working class. It might be especially politically risky for President Trump to disappoint the core of his populist support.

Reforms to make healthcare cheaper and to expand the insurance market could be a way for the GOP to promote healthcare reform in a less politically risky way; this approach might also do a lot of good to improve access to medical care.

A good bill passed slowly is far better for a governing party than a bad bill passed quickly.

Some Assorted Links

An interesting treatment in The Chronicle of Higher Education of the Claremont Institute, Straussian thinking, and some intellectuals who support Donald Trump.  (It could be seen as a kind of companion piece to this NYT story on the new journal American Affairs.)

Henry Olsen worries that the current iteration of the American Health Care Act may disappoint the working-class voters who were crucial for the GOP victory in 2016.

Ross Douthat reflects on the worries of some who fear that Jane Austen has too many "alt-right" fans.  A particularly striking claim: efforts by the far left to "abolish canons and police certain forms of memory" may in part be motivated by a desire to suppress the diversity of cultural expression in the past.

On Political Winning

In light of the current debate over health-care reform,  few points about "winning":  In the Beltway, there tends to be an assumption that a president "wins" when he gets Congress to pass the legislation he supports.  Than can be a victory, but that "win" can sow the seeds for a greater defeat later.

For instance, President Obama "won" by getting Congress to pass the ACA on a party-line vote.  It was a substantial legislative achievement, and components of it could very well have a long legacy.  But the ACA's passage also crippled the rest of the Obama administration's agenda and contributed to the evisceration of the Democratic party's bench.  Maybe that trade was worth it, but it exacted a high long-term political price, too.

The experience of the Obama administration might prompt the Trump White House to think about what its real policy priorities are and how it can advance those priorities without endangering a critical mass of public support.

Maintaining Judicial Norms

Judge Derrick Watson's ruling on the Trump travel ban has ignited commentary about the role of the judiciary vis-a-vis the presidency and existing constitutional norms.  At Lawfare, Benjamin Wittes and Quinta Jurecic raise a potentially quite troubling permutation: the rise of the judiciary as a partisan political actor.  For this model of the judiciary, norms about institutions and constitutional principles would pale before the way judges feel about the holders of certain offices:

Imagine a world in which other actors have no expectation of civic virtue from the President and thus no concept of deference to him. Imagine a world in which the words of the President are not presumed to carry any weight. Imagine a world in which far more judicial review of presidential conduct is de novo, and in which the executive has to find highly coercive means of enforcing message discipline on its staff because it can’t depend on loyalty. That’s a very different presidency than the one we have come to expect.
It’s actually a presidency without the principle that we separate the man from the office. It’s a presidency in which we owe nothing to the office institutionally and make individual decisions about how to interact with it based on how much we trust, like, or hate its occupant.

A world where the judiciary interprets law based not on precedent and institutional principles but instead on its feelings about individuals would be one where judicial philosophy would become much less stable (if we could even call it a "philosophy" at all).  It would likely endanger public faith in the judiciary as a responsible institutional actor and could contribute to greater public distrust about important constitutional stakeholders.

Partisan politics can blind us to the consequences of our actions, but civic (and ethical) responsibility demands that we try to account for these consequences.  That responsibility weighs especially on those in the judicial branch.

(Over at the Corner, I think about the consequences of Judge Watson's ruling for future immigration legislation.)

Leverage

Jim Geraghty raises an interesting point: The GOP is offering the AHCA as "Phase 1" in a three-phrase process.  The second "phase" is President Trump's rewriting of the Obama administration's ACA regulations, and the third would be more market-oriented (and perhaps more popular) legislative reforms, such as selling insurance over state lines.

Geraghty, though, wonders whether there will be enough bipartisan energy to pass "Phase 3":

Assume the American Health Care Act passes the House, at least 50 Republicans in the Senate vote for it and Trump signs it into law.

For "Phase Three," will eight Senate Democrats be eager to vote with Republicans to make further reforms? If you’re a Democrat, after AHCA passes, Republicans "own" the status quo on the health care system. You can blame AHCA for anything any constituent doesn’t like about their insurance, their premiums, their co-pays, their deductibles, or their quality of care. It may or may not be accurate, but let’s face it, accuracy has never mattered much in attack ads.

Perhaps naively, I believe that there could be a chance getting at least 60 Senate votes--including at least 8 Democrats--to support broadly popular reforms that would increase efficiency in the health-care market.

However, there is a possibility that this chance gets slimmer after the passage of "Phase 1."  Currently, Republicans can still blame the many shortcomings of the current health-care system on the legacy of the Affordable Care Act.  They can try to use these shortcomings as a way of putting pressure on Democrats in swing and lean-Republican states: We're trying to fix the broken system left to us by Obamacare, and you're just obstructing.

That dynamic changes, however, if a major piece of health-care legislation (like the AHCA) is passed on a party-line vote.  Then, it gets much harder to blame a "broken system" on the ACA alone.  Passing the AHCA gives vulnerable Senate Democrats an obvious retort: Nuh-uh, you guys broke the system with Trumpcare.

With this political cover, Democrats would have the temptation to obstruct any further changes to the health-care system leading up to the 2018 elections.  The obvious strategy would be to attack (fairly or not) the AHCA for denying care to the poor and vulnerable in order to give tax-cuts to corporations and "the 1%".  Democrats saw how well attacking a major piece of health-care reform passed on a party-line vote worked for Republicans in 2010; they might try to repeat that in 2018.

The recent political cycle has laid to waste many predictions, so any predictions about the future political dynamic should be made in a hypothetical rather than categorical mode.  Nevertheless, it seems as though Republicans could lose some leverage over Senate Democrats if they pass a party-line major health-care reform.  That leverage may be crucial if they hope to pass later reforms to health-care law this Congress; these reforms would require 60 votes in the Senate and so would need some Democratic support.

If Republicans want to enact major changes in health-care regulations (not just government financing), they might have more political leverage before passing a party-line bill than after passing such a bill.

(Two related points: Some folks have raised a possible counterargument to this narrative of leverage: Once the ACA is reformed through a party-line vote on the AHCA, Democrats will have less incentive to defend the ACA in its entirety and will be more willing to compromise on other areas.  At that point, it will no longer be about defending President Obama's "legacy" and more about pragmatically working to improve national health-care.  In a less politically polarized time, this counterargument would have more force, but it could still be plausible.

Also, if something like the AHCA did pass in its current form, one possible bargaining chip to get Democrats to support a later wave of reform would be to offer to increase Medicaid subsidies.)

The Health-Care Bind

One of the more interesting pieces published today was this one by Christopher Ruddy, the head of Newsmax and a friend of President Trump.  Ruddy argues that the president should reject the calls of Republicans who want to limit Medicaid and other subsidies in the American Health Care Act; instead, President Trump should call for an expanded Medicaid program (albeit one that has more power delegated to the states).  Ruddy worries about the political effects of trying to push entitlement reform in replacing the Affordable Care Act:

Today, I am amazed that House Republicans haven't given up on their political death wish.
Interestingly, Ryan Plan II accepts key parts of the Obamacare law that benefit the insurance industry. But it ends the Medicaid expansion program that benefits the poor and keeps costs down.
Instead, Ryan II forces poor individuals back into the private health insurance market with the help of tax credits. I wonder who that benefits?
According to the AARP, Ryan Plan II also cuts Medicare, a program Trump voters clearly want protected.
The CBO is estimating 14 million Americans will lose coverage compared to Obamacare.
This number may be inflated, but limiting Medicaid coverage for the poorest will most certainly leave millions without coverage.
The most significant problem is that Ryan Plan II doesn't fulfill Trump's own vision of universal healthcare while removing the onerous requirements of Obamacare.

When even the CEO of Newsmax calls for an expanded Medicaid program, it's clear that the political dynamic is quickly evolving.  Ruddy's sentiments echo those of others in the Trumposphere who fear that there could be a significant political price to be paid if the Republicans try to push through health-care reform that causes some Americans to feel as though they're losing access to health-care (the CBO numbers from yesterday surely have added fuel to that burning worry).

Whether or not an expanded Medicaid program is the right answer, it seems clear that the GOP is torn between those who fear that the AHCA does not cut subsidies enough (such as the Freedom Caucus) and those who fear that the already existing reduction of subsidies in the AHCA could ignite a political backlash among working-class voters.  It remains unclear whether the GOP can thread the needle and appease enough of both sets of Republicans in order to get 218 votes in the House and 51 votes in the Senate.

The battle over health-care subsidies divides the GOP and risks alienating the blue-collar voters who are a central component of Trump's coalition.  One way around these risks is to defer fighting this battle and instead focus more immediately on market-oriented reforms to the health-care market itself.  Expanding and diversifying health-care markets, reforming licensing laws, pushing for more transparency in medical pricing, and other efforts are far less divisive for GOP voters and could also win some support from Democrats and independents.  As David Frum has noted, the American health-care system stands in need of more market efficiency, and Republicans could be well positioned to champion that cause of efficiency in a way that will ease government budgets and the concerns of health-care consumers (i.e., voters).

If policymakers can lower health-care costs or at least reduce the rate of growth for health-care costs, more room opens up for negotiations over government mechanisms to pay for health-care.  A more market-oriented health-care system might facilitate more market-oriented ways of financing this system.

Of course, these market-oriented reforms can't for the most part be passed via reconciliation.  As a result, right now some in Republican leadership are fighting on the ground of health-care reform where the party might be most vulnerable and leaving more favorable territory for a later day.

Debating Marcuse

In National Review Online over the weekend, I discussed the unrest at Middlebury in the context of Herbert Marcuse's theory of "discriminating tolerance."  A prominent member of the Frankfurt School, Marcuse offered a flawed model of tolerance that, I fear, fosters a breakdown of public debate.

Marcuse must have been in the air last week, because Stephen L. Carter also had an interesting critique of Marcuse over at Bloomberg View.

(And if you're in the mood for more on Marcuse, you might check out George Kateb's extended comments on him from a 1970 issue of Commentary.)

Hidden Costs

Christopher Caldwell's survey of the opioid epidemic, featured in the latest issue of First Things, has understandably been getting a lot of attention.  Caldwell explores the personal and social costs of opioid epidemic rocking many communities in the United States.  The death-rate from opioids currently far exceeds the death-rate from the headline drugs of other crises:

A heroin scourge in America’s housing projects coincided with a wave of heroin-addicted soldiers brought back from Vietnam, with a cost peaking between 1973 and 1975 at 1.5 overdose deaths per 100,000. The Nixon White House panicked. Curtis Mayfield wrote his soul ballad “Freddie’s Dead.” The crack epidemic of the mid- to late 1980s was worse, with a death rate reaching almost two per 100,000. George H. W. Bush declared war on drugs. The present opioid epidemic is killing 10.3 people per 100,000, and that is without the fentanyl-impacted statistics from 2016. In some states it is far worse: over thirty per 100,000 in New Hampshire and over forty in West Virginia.

As Caldwell notes elsewhere in his story, four times as many Americans died from overdoses in 2015 as died from gun homicides that year.

Federal data shows how quickly deaths from heroin and opioids more generally have skyrocketed over the past decade.  Heroin deaths across the nation jumped from around 2,000 in 2006 to about 12,000 by 2015.  The number of deaths from opioid overdoses has over doubled since 2004.  The number of overall drug overdose deaths has over doubled since 2002.

The causes of this increased rate of opioid abuse are complex.  Caldwell suggests that the normalization of increasingly powerful opioids by the medical community played a role, as did an influx of cheap heroin.  The story also frames the opioid crisis in the context of broader socioeconomic forces that have battered many communities.

Of course, we cannot measure the current opioid epidemic only in terms of lives lost.  Drug addiction can be lethal, but its costs can also be measured in other ways--in broken families, frayed communities, daily struggles, grappling with despair, and the haunting of personal disappointment.  All these things suggest that drug abuse remains a serious civil issue.

AHCA Tensions

At National Review, I reflect on some of the political tensions facing the GOP in terms of reforming health-care.

Ross Douthat also considers some of those challenges in the NYT today.  He argues that fractures in the Republican party have put it in a place of policy confusion.  Leadership and imagination can remedy some of that confusion, but they will have to be demonstrated.

On Sessions

Attorney General Jeff Sessions has recused himself from investigations into foreign involvement in the 2016 election.

Over at National Review, I note that members of Congress on both sides of the aisle have had contact with the Russian ambassador to the United States.