Archive for the ‘Medical’ Category
Alex Morris writes in Rolling Stone:
At 6:35 a.m. on the morning of March 4th, President Donald Trump did what no U.S. president has ever done: He accused his predecessor of spying on him. He did so over Twitter, providing no evidence and – lest anyone miss the point – doubling down on his accusation in tweets at 6:49, 6:52 and 7:02, the last of which referred to Obama as a “Bad (or sick) guy!” Six weeks into his presidency, these unsubstantiated tweets were just one of many times the sitting president had rashly made claims that were (as we soon learned) categorically untrue, but it was the first time since his inauguration that he had so starkly drawn America’s integrity into the fray. And he had done it not behind closed doors with a swift call to the Department of Justice, but instead over social media in a frenzy of ire and grammatical errors. If one hadn’t been asking the question before, it was hard not to wonder: Is the president mentally ill?
It’s now abundantly clear that Trump’s behavior on the campaign trail was not just a “persona” he used to get elected – that he would not, in fact, turn out to be, as he put it, “the most presidential person ever, other than possibly the great Abe Lincoln, all right?” It took all of 24 hours to show us that the Trump we elected was the Trump we would get when, despite the fact that he was president, that he had won, he spent that first full day in office focused not on the problems facing our country but on the problems facing him: his lackluster inauguration attendance and his inability to win the popular vote.
Since Trump first announced his candidacy, his extreme disagreeableness, his loose relationship with the truth and his trigger-happy attacks on those who threatened his dominance were the worrisome qualities that launched a thousand op-eds calling him “unfit for office,” and led to ubiquitous armchair diagnoses of “crazy.” We had never seen a presidential candidate behave in such a way, and his behavior was so abnormal that one couldn’t help but try to fit it into some sort of rubric that would help us understand. “Crazy” kind of did the trick.
And yet, the one group that could weigh in on Trump’s sanity, or possible lack thereof, was sitting the debate out – for an ostensibly good reason. In 1964, Lyndon B. Johnson had foreshadowed the 2016 presidential election by suggesting his opponent, Barry Goldwater, was too unstable to be in control of the nuclear codes, even running an ad to that effect that remains one of the most controversial in the history of American poli tics. In a survey for Fact magazine, more than 2,000 psychiatrists weighed in, many of them seeing pathology in Goldwater’s supposed potty-training woes, in his supposed latent homosexuality and in his Cold War paranoia. This was back in the Freudian days of psychiatry, when any odd-duck characteristic was fair game for psychiatric dissection, before the Diagnostic and Statistical Man ual of Mental Disorders cleaned house and gave a clear set of criteria (none of which includes potty training, by the way) for a limited number of possible dis orders. Goldwater lost the election, sued Fact and won his suit. The American Psychiatric Asso ciation was so embarrassed that it instituted the so-called Goldwater Rule, stating that it is “un ethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination” of the person under question.
All the same, as Trump’s candidacy snowballed, many in the mental-health community, observing what they believed to be clear signs of pathology, bristled at the limitations of the Goldwater guidelines. “It seems to function as a gag rule,” says Claire Pouncey, a psychiatrist who co-authored a paper in The Journal of the American Academy of Psychiatry and Law, which argued that upholding Goldwater “inhibits potentially valuable educational efforts and psychiatric opinions about potentially dangerous public figures.” Many called on the organizations that traffic in the psychological well-being of Americans – like the American Psychiatric Association, the American Psychological Association, the National Association of Social Workers and the American Psychoanalytic Association – to sound an alarm. “A lot of us were working as hard as we could to try to get organizations to speak out during the campaign,” says Lance Dodes, a psychoanalyst and former professor of psychiatry at Harvard Medical School. “I mean, there was certainly a sense that somebody had to speak up.” But none of the organizations wanted to violate the Goldwater Rule. And anyway, Dodes continues, “Most of the pollsters said he would not be elected. So even though there was a lot of worry, people reassured themselves that nothing would come of this.”
But of course, something did come of it, and so on February 13th, Dodes and 34 other psychiatrists, psychologists and social workers published a letter in The New York Times stating that “Mr. Trump’s speech and actions make him incapable of safely serving as president.” As Dodes tells me, “This is not a policy matter at all. It is continuous behavior that the whole country can see that indicates specific kinds of limitations, or problems in his mind. So to say that those people who are most expert in human psychology can’t comment on it is nonsensical.” In their letter, the mental health experts did not go so far as to proffer a diagnosis, but the affliction that has gotten the most play in the days since is a form of narcissism so extreme that it affects a person’s ability to function: narcissistic personality disorder.
The most current iteration of the DSM classifies narcissistic personality disorder as: “A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts.” A diagnosis would also require five or more of the following traits:
1. Has a grandiose sense of self-importance (e.g., “Nobody builds walls better than me”; “There’s nobody that respects women more than I do”; “There’s nobody who’s done so much for equality as I have”).
2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty or ideal love (“I alone can fix it”; “It’s very hard for them to attack me on looks, because I’m so good-looking”).
3. Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people or institutions (“Part of the beauty of me is that I’m very rich”).
4. Requires excessive admiration (“They said it was the biggest standing ovation since Peyton Manning had won the Super Bowl”).
5. Has a sense of entitlement (“When you’re a star, they let you do it. You can do anything. Grab them by the pussy”).
6. Is interpersonally exploitative (see above).
7. Lacks empathy, is unwilling to recognize or identify with the feelings and needs of others (“He’s not a war hero . . . he was captured. I like people that weren’t captured”).
8. Is often envious of others or believes that others are envious of him or her (“I’m the president, and you’re not”).
9. Shows arrogant, haughty behaviors or attitudes (“I could stand in the middle of 5th Avenue and shoot somebody, and I wouldn’t lose any voters”).
NPD was first introduced as a personality disorder by the DSM in 1980 and affects up to six percent of the U.S. population. It is not a mood state but rather an ingrained set of traits, a programming of the brain that is thought to arise in childhood as a result of parenting that either puts a child on a pedestal and superficially inflates the ego or, conversely, withholds approval and requires the child to single-handedly build up his or her own ego to survive. Either way, this impedes the development of a realistic sense of self and instead fosters a “false self,” a grandiose narrative of one’s own importance that needs constant support and affirmation – or “narcissistic supply” – to ward off an otherwise prevailing sense of emptiness. Of all personality disorders, NPD is among the least responsive to treatment for the obvious reason that narcissists typically do not, or cannot, admit that they are flawed.
Trump’s childhood seems to suggest . . .
The Four Horsemen Signaling the Death of a Relationship: Criticism, Contempt, Defensiveness, and Stonewalling
I”ve been reading with interest some stuff from Gottman.com and thought I’d point out this post on the Gottman website:
Today on The Gottman Relationship Blog, we would like to continue The Four Horsemen series by providing you with a strong foundation of understanding before we go into further depth about each specific communication style. Consider today’s posting an overview of what is to come over the next four weeks.
The Four Horsemen of the Apocalypse is a metaphor depicting the end of times in the New Testament. They describe conquest, war, hunger, and death respectively. Dr. Gottman uses this metaphor to describe communication styles that can predict the end of a relationship.
The first horseman of the apocalypse is criticism. Criticizing your partner is different than offering a critique or voicing a complaint! The latter two are about specific issues, whereas the former is an ad hominem attack: it is an attack on your partner at the core. In effect, you are dismantling his or her whole being when you criticize.
- Complaint: “I was scared when you were running late and didn’t call me. I thought we had agreed that we would do that for each other.”
- Criticism: “You never think about how your behavior is affecting other people. I don’t believe you are that forgetful, you’re just selfish! You never think of others! You never think of me!”
If you find that you are your partner are critical of each other, don’t assume your relationship is doomed to fail. The problem with criticism is that, when it becomes pervasive, it paves the way for the other, far deadlier horsemen. It makes the victim feel assaulted, rejected, and hurt, and often causes the perpetrator and victim to fall into an escalating pattern where the first horseman reappears with greater and greater frequency and intensity.
The second horseman is contempt. When we communicate in this state, we are truly mean – treating others with disrespect, mocking them with sarcasm, ridicule, name-calling, mimicking, and/or body language such as eye-rolling. The target of contempt is made to feel despised and worthless.
“You’re ‘tired?’ Cry me a river. I’ve been with the kids all day, running around like mad to keep this house going and all you do when you come home from work is flop down on that sofa like a child and play those idiotic computer games. I don’t have time to deal with another kid – try to be more pathetic…”
In his research, Dr. Gottman found that couples that are contemptuous of each other are more likely to suffer from infectious illness (colds, the flu, etc.) than others, as their immune systems weaken! Contempt is fueled by long-simmering negative thoughts about the partner – which come to a head in the perpetrator attacking the accused from a position of relative superiority. Contempt is the single greatest predictor of divorce according to Dr. Gottman’s work. It must be eliminated!
The third horseman is defensiveness. We’ve all been defensive. This horseman is nearly omnipresent when relationships are on the rocks. When we feel accused unjustly, we fish for excuses so that our partner will back off. Unfortunately, this strategy is almost never successful. Our excuses just tell our partner that we don’t take them seriously, trying to get them to buy something that they don’t believe, that we are blowing them off.
- She: “Did you call Betty and Ralph to let them know that we’re not coming tonight as you promised this morning?”
- He: “I was just too darn busy today. As a matter of fact you know just how busy my schedule was. Why didn’t you just do it?”
He not only responds defensively, but turns the table and makes it her fault. A non-defensive response would have been: . . .
It’s a very bad sign when the state actively works against the interests of its citizens while hiding its actions from the courts. Joaquin Sapien writes in ProPublica:
A federal judge in Brooklyn has accused state officials of secretly trying to subvert a landmark court order to improve care for thousands of mentally ill residents of New York City.
Three years ago, U.S. District Judge Nicholas Garaufis ended a prolonged lawsuit against New York state by ordering the Department of Health to begin moving as many as 4,000 mentally ill residents housed in group homes to less restrictive environments where they could live more independently. As part of his order, the judge had laid out a timetable for the state to meet its obligations to men and women who had long lived in homes marked by neglect and abuse.
But at a hearing last month, Garaufis angrily charged that officials with the Department of Health appeared to have hatched a plan with the operators of the troubled group homes to get out from under his court order.
“There’s some sort of a deal,” Garaufis said. “That’s how it appears. And we’re going to find out exactly what the deal is, because if there is a deal, I would consider it a fraud on the court.”
A spokesman for the Department of Health said there was no secret plan, and that the state remained committed to meeting its obligations under the court order. A spokesman for the attorney general’s office, which has represented the state in the litigation for more than a decade, denied its lawyers were complicit in any effort to subvert the court order. The attorney general’s office has in recent weeks sought to distance itself from the Department of Health.
The development amounted to a remarkable moment in a case that began 15 years ago with a series of exposés in The New York Times. The articles portrayed a life of misery and exploitation for vulnerable people who had been discharged from state psychiatric hospitals only to wind up effectively warehoused in for-profit homes run by operators little interested in the well-being of their residents.
Lawyers for the residents soon filed suit, and what followed were years of hearings, depositions, a lengthy trial, a successful appeal, and eventually the intervention of the U.S. Department of Justice. Ultimately, Garaufis issued his order, and installed an independent monitor to make sure the state made good on its promises to first assess, and then relocate, residents from some of the biggest and most troubled adult homes in New York City.
Garaufis was alerted to the idea that the state was working to undercut his order in February as the Department of Health prepared to update the court on its progress in relocating residents. Garaufis said the scheme, as he saw it, involved efforts by the adult home industry to have critical regulations at the heart of the 2014 settlement effectively voided. The regulations limited the ability of home operators to accept new mentally ill residents.
In laying out the alleged secret deal, Garaufis said lawyers for the adult home operators had met with officials from the Department of Health, and that they basically worked together to have a state judge issue a temporary restraining order governing the regulations. The action by the state judge, Kimberly A. O’Connor, triggered a provision in Garaufis’ order.
Under the terms of the federal order, any dispute over the regulations that cannot be resolved in 120 days would mean the entire consent decree governing the residents of the homes would be voided. Why the fate of the settlement was being litigated in state court without his knowledge, Garaufis said, was incomprehensible.
Furious, Garaufis held a hearing on March 22, one he required be attended by the state commissioner of health, the commissioner of mental health and the counsel to Gov. Andrew M. Cuomo. He excoriated the group and said he was enraged that the residents of the homes were caught up in politics.
“If I sound dramatic, it is because it is dramatic,” Garaufis said. “It’s about them. It’s about 4,000 people.”
“I will not allow the kind of political, legal activity that is going on in this case behind my back and behind the backs of the plaintiffs to continue,” he said.
ProPublica sent requests for comment to Cuomo’s office, but got no response. A request to speak directly with Attorney General Eric Schneiderman was denied.
At the hearing in March, Garaufis authorized lawyers representing the mentally ill residents to depose an array of state officials and said if a new trial was required, he would conduct it in July, and he would require the state commissioners to attend it. He also said he was intent on exploring possible sanctions against the state.
Lawyers with one of the city’s most prestigious law firms, Paul, Weiss, Rivkind, Wharton and Garrison, have worked on behalf of the mentally ill residents for more than a decade. At the hearing in March, Garaufis allowed a lawyer from the firm to respond to the state’s conduct.
“I don’t even know how to catalogue my outrage,” the lawyer, Andrew Gordon, said. “I mean, whether it’s the court’s efforts, Paul, Weiss’s efforts over the last 10 years, whether it is the fact that it appears that a federal order of this court has been ignored, whether it is the fact that the Department of Health and Office of Mental Health — who are charged with protecting one of the most vulnerable populations — appears to be in cahoots with the adult home industry. I don’t even know where to start.” . . .
Jeff Guo makes an excellent point in his report in the Washington Post:
For the past year and a half, Princeton economists Anne Case and Angus Deaton have been ringing the alarm about rising mortality among middle-aged white Americans.
The pair have attracted a bit of controversy for pointing out these facts. Recently, Pacific Standard’s Malcolm Harris suggested that their research, and the way it was presented, put too much emphasis on white mortality — when black mortality has always been worse. “American white privilege is still very much in effect, and no statistical tomfoolery can change that,” he wrote.
Sam Fulwood III, a fellow at the left-leaning Center for American Progress, worried that Case and Deaton’s work would further amplify a growing narrative about white working class woes, to the exclusion of the African American experience. “I worry about how political people will manipulate Case and Deaton’s findings to argue for more aid for white people, but ignore the same, long-standing concerns of people of color,” he wrote last week.
Case and Deaton point out that the trend of increasing white American mortality — higher death rates in middle age — is noteworthy because those death rates have been going down for nearly everyone else: for African Americans, Latino Americans, for people in the U.K. and Germany and France. When we’re used to life getting better, it’s unusual to see life getting worse.
“It’s not as much news if people’s mortality rates are falling the way you would hope they are falling,” Case said in an interview Monday. “What seems like news is when mortality has stopped falling, and no one has noticed that it has stopped.” That’s what happened in the case of white Americans, she said.
But the critics on the left do have a point, which is that the statistics about black mortality may have not gotten enough attention in the media. So it’s worth straightening that out right now: Black Americans have long been dying faster than white Americans. They’ve long been less happy than white Americans.
Now, though, the two groups are starting to look more and more alike. Particularly among those on the bottom rungs of the socioeconomic ladder, class has become equally — if not more important — than race as a predictor of people’s health and emotional well-being.
Case and Deaton have a chart showing the declining mortality gap between black and white people without a college degree. Back in 1995, black Americans with a high school education or less were dying at more than twice the rate of similar white Americans. Since then, black mortality has been declining, while white mortality has been climbing. In recent years, the two groups have more or less met in the middle. . .
Continue reading. The article includes some charts that show what he’s talking about.
I’m not really a sports fan and the NFL leaves me cold, especially since we now know the damage being done to the players, but Christopher Ingraham has a very good report on some reforms that could help the players (but since the reforms make no money for the owners, it will be an uphill struggle). He writes in the Washington Post:
The owner of the Dallas Cowboys said in a recent meeting of NFL owners that the league should “drop its prohibition on marijuana use,” according to Pro Football Talk’s Mike Florio.
While recreational marijuana use is legal in eight states plus D.C., and medical marijuana is legal is about 20 more, NFL players are banned from using the drug for any purposes under the existing collective bargaining agreement, which expires in 2020. Under that agreement, players who test positive for marijuana must enter a substance abuse program. Subsequent violations lead to fines, 10-game suspensions, and, ultimately, banishment from the league.
Former NFL players have been increasingly vocal in their criticism of the ban in recent years, saying that medical marijuana is a safe alternative to the powerful prescription opiates routinely prescribed to NFL players for pain. Documents obtained by The Post earlier this yearshow that NFL teams are heavy users of prescription pain medications, averaging about “six to seven pain pills or injections a week per player over the course of a typical NFL season.”
Science, as it turns out, is on the players’ — and now Jones’s — side.
There’s little evidence that opiates work for the chronic aches and pains often suffered by football players. But there’s strong evidence that anyone, NFL pro or otherwise, who uses opiates on a long-term basis is putting themself at serious risk for drug dependency, overdose and death.
A 2014 review of 39 studies investigating the efficacy of opiate painkillers for chronic pain found that “evidence on long-term opioid therapy for chronic pain is very limited but suggests an increased risk of serious harms that appear to be dose-dependent.” In other words, there’s little evidence of benefit for treating chronic pain with opioids, but a there is a real risk of harm.
The implications of this finding shouldn’t be understated, for either NFL players or the public. Opiate painkillers, like the ones prescribed in bulk by the NFL, kill over 15,000 people a year via overdose. No death from a marijuana overdose has been reported, according to the DEA.
On the other hand, chronic pain is one of the conditions that marijuana has been shown to be effective at treating. Earlier this year the National Academies of Sciences, Engineering and Medicine published an expansive literature review, spanning decades of research, showing “substantial evidence that cannabis is an effective treatment for chronic pain in adults.”
The NFL, in other words, is pumping its players full of highly addictive and deadly substances that are of dubious use for treating the long-term, chronic pain suffered by so many players — and fining and suspending players who choose instead to self-medicate with a less-addictive and nonlethal substance.
The disproportionality of the league’s substance abuse policy was put into stark relief in 2015, when the Browns’ Josh Gordon received a year-long suspension for multiple violations of the league’s marijuana ban. When Ravens running back Ray Rice was charged with aggravated assault for beating his then-fiancee, his initial suspension from the league was only two games. . .
It seems obvious to me that there is something seriously wrong with the NFL, and the NFL is not going to look at it.
German Lopez has a good report in Vox, with video at the link:
When New Jersey Gov. Chris Christie discusses his compassionate approach to the ongoing opioid epidemic, he frequently brings up a close friend from law school. He describes this friend as perfect — incredibly smart, with a successful law practice, with a beautiful and brilliant wife and kids, and both good looking and athletic. “So we loved him, but we hated him,” Christie joked at a 2015 town hall. “Because the guy had everything, right?”
This friend, however, had a drug problem. Starting with a back injury from running, he was prescribed opioid painkillers. That initial prescription eventually grew into a full-blown addiction. And despite Christie’s and others’ attempts to help, the addiction consumed his friend, who Christie has kept anonymous to protect the family from media attention. Over the next 10 years, despite some stints in rehab, his friend lost his wife, his home, his money, the ability to see his girls, his law practice, and even his driver’s license. Then, he overdosed and died at 52 years old.
“By every measure that we define success in this country, this guy had it,” Christie said. “He’s a drug addict. And he couldn’t get help. And he’s dead.” He added, “When I sat there as the governor of New Jersey at his funeral, and looked across the pew at his three daughters sobbing ’cause their dad is gone, there but for the grace of God go I. It can happen to anyone. And so we need to start treating people in this country, not jailing them. We need to give them the tools they need to recover, because every life is precious.”
This is the kind of story that not just Christie but countless lawmakers across the US have told in reaction to the opioid epidemic: how a close experience with a personal friend or family member drove them to understand drug addiction and the opioid crisis in a much more compassionate way — one that emphasizes treating drug misuse as a public health issue.
Similarly, President Donald Trump, who appointed Christie to a commission studying the opioid epidemic, often brings up the alcohol addiction that consumed and killed his brother. Businesswoman Carly Fiorina, who briefly ran for president in 2016, also mentionedher daughter’s death due to drugs on the campaign trail. Former Florida Gov. Jeb Bush wrote an article on his daughter’s drug struggles on Medium. And that doesn’t even begin to get into the many, many state lawmakers who have shared similar stories about husbands, wives, sons, daughters, friends, and coworkers who struggled with addiction.
This, they all say, has led them to believe in the need for better, comprehensive drug treatment.
These stories show how lived experiences and personal relationships can influence serious policy decisions. After all, politicians bring up the people in their lives who they saw needlessly suffer and die due to drugs for a specific purpose: to call for an approach to addiction focused on public health over criminal justice.
But in this way, these stories also expose the impact of another issue that may not seem related at first: race.
Even after decades of progress on racial issues, America remains a very segregated country. On a day to day basis, most Americans closely interact only with people of the same race. And that impacts our policies.
Consider the opioid epidemic, which contributed to the record 52,000 drug overdose deaths reported in 2015. Because the crisis has disproportionately affected white Americans, white lawmakers — who make up a disproportionate amount of all levels of government — are more likely to come into contact with people afflicted by the opioid epidemic than, say, the disproportionately black drug users who suffered during the crack cocaine epidemic of the 1980s and ’90s. And that means a lawmaker is perhaps more likely to have the kind of interaction that Christie, Trump, Bush, and Fiorina described — one that might lead them to support more compassionate drug policies — in the current crisis than the ones of old.
Is it any wonder, then, that the crack epidemic led to a “tough on crime” crackdown focused on harsher prison sentences and police tactics, while the current opioid crisis has led more to calls for legislation, including a measure Congress passed last year, that boosted spending on drug treatment to get people with substance use disorders help?
Ithaca, New York, Mayor Svante Myrick, who’s black, told me this has led to resentment in much of the black community in his predominantly white town. “It’s very real,” he acknowledged. The typical response from his black constituents, he said, goes something like this: “Oh, when it was happening in my neighborhood it was ‘lock ’em up.’ Now that it’s happening in the [largely white, wealthy] Heights, the answer is to use my tax dollars to fund treatment centers. Well, my son could have used a treatment center in 1989, and he didn’t get one.”
Still, Myrick added, “I’m as angry about this as anybody. But just because these are now white kids dying doesn’t mean we shouldn’t care, because these are still kids dying.”
Stories like Christie’s, Trump’s, Fiorina’s, and Bush’s show one of the many ways we got to this point, where a policy response can vary largely based on a victim’s race. They demonstrate that it’s not just personal racism that can lead to racially disparate policies, but structural factors like segregation as well. . .
The US really needs to look at how racism is baked into our institutions, social structures, and daily lives. Until we talk about how race matters a lot in daily life, and listen with empathy to those who endure the on-going impact of racism, we as a nation will continue to be weakened by fault lines the prevent us (as a nation) from reaching our full potential.
Read the full article. There’s a lot more.
Conor Friedersdorf writes in the Atlantic:
As the Republican Party struggled and then failed to repeal and replace Obamacare, pulling a wildly unpopular bill from the House without even taking a vote, a flurry of insightful articles helped the public understand what exactly just happened. Robert Draper explained the roles that Stephen Bannon, Paul Ryan, and others played in deciding what agenda items President Trump would pursue in what order. Politico reported on how and why the House Freedom Caucus insisted that the health care bill repeal even relatively popular parts of Obamacare. Lest anyone pin blame for the GOP’s failure on that faction, Reihan Salam argued persuasively that responsibility rests with poor leadership by House Speaker Paul Ryan and a GOP coalition with “policy goals that simply can’t be achieved.”
But dogged, behind-the-scenes reporting and sharp analysis of fissures among policy elites do not capture another important contributor to last week’s failure—one Josh Barro came closest to unpacking in a column titled, “Republicans lied about healthcare for years, and they’re about to get the punishment they deserve.”
The article isn’t an attack on conservatives and libertarians.
Plenty of plausible alternatives to Obamacare have been set forth by people who are truthful about the tradeoffs involved. For instance, The Atlantic published a plan in 2009; Ezra Klein and Avik Roy usefully illuminated the disagreements between serious conservative and progressive health-care wonks; and Ross Douthat suggested reforms that borrow heavily from Singapore. Barro is aware of many smart right-leaning critiques of Obamacare and sympathetic to some.
What he points out in his column is that the GOP didn’t honestly acknowledge the hard tradeoffs inherent in health-care policy before making the case for a market-driven system.
Republicans tried to hide the fact of tradeoffs:
For years, Republicans promised lower premiums, lower deductibles, lower co-payments, lower taxes, lower government expenditure, more choice, the restoration of the $700 billion that President Barack Obama heartlessly cut out of Medicare because he hated old people, and (in the particular case of the Republican who recently became president) “insurance for everybody” that is “much less expensive and much better” than what they have today. They were lying. Over and over, Republicans lied to the American public about healthcare. It was impossible to do all of the things they were promising together, and they knew it.
That is basically correct. And it helps explain how Republicans could win a presidential election and lots of congressional elections on the promise of repealing and replacing Obamacare, only to produce a bill that was wildly unappealing to voters.
Once Republicans commenced governing, the tradeoffs couldn’t be elided any longer.
Still, even the insight that Republicans spent years willfully obscuring the tradeoffs involved in health-care policy doesn’t fully explain the last week. Focusing on GOP officials leaves out yet another important actor in this debacle: the right-wing media. By that, I do not mean every right-leaning writer or publication. Over the last eight years, lots of responsibly written critiques of Obamacare have been published in numerous publications, and folks reading the aforementioned wonks, or Peter Suderman at Reason, or Yuval Levin, or Megan McArdle at Bloomberg, stayed reasonably grounded in the actual shortcomings of Obamacare.
n contrast, Fox News viewers who watched entertainers like Glenn Beck, talk-radio listeners who tuned into hosts like Rush Limbaugh, and consumers of web journalism who turned to sites like Breitbart weren’t merely misled about health-care tradeoffs.
They were told a bunch of crazy nonsense.
As I was drafting this article, Ted Koppel made headlines by telling Fox News entertainer Sean Hannity that he is bad for America. This upset some conservatives, who felt it was just another instance of the mainstream media attacking a fellow conservative. I don’t think that conservatives are typically bad for America. But I lament the fact that Hannity is still employed in my industry, in large part because his coverage of subjects like Obamacare is dishonest—and I say that as someone who has preferred a very different health-care policy since 2009. . .