Monday, December 23, 2024
Sunday, December 22, 2024
Why Are So Many Christians So Cruel?
Here’s a question I hear everywhere I go, including from fellow Christians: Why are so many Christians so cruel?
I can’t tell you the number of times I’ve heard someone say something like: I’ve experienced blowback in the secular world, but nothing prepared me for church hate. Christian believers can be especially angry and even sometimes vicious.
It’s a simple question with a complicated answer, but that answer often begins with a particularly seductive temptation, one common to people of all faiths: that the faithful, those who possess eternal truth, are entitled to rule. Under this construct, might makes right, and right deserves might.
Most of us have sound enough moral instincts to reject the notion that might makes right. Power alone is not a sufficient marker of righteousness.
The idea that right deserves might is different and may even be more destructive. It appeals to our ambition through our virtue, which is what makes it especially treacherous. It masks its darkness. It begins with the idea that if you believe your ideas are just and right, then it’s a problem for everyone if you’re not in charge. . . . . In that context, your own will to power is sanctified.
The practical objections to this mind-set are legion. How can we be so certain of our own righteousness? Even if we are right or have a superior vision of justice compared with our opponents, the quest for power can override the quest for justice.
The historical examples are too numerous to list. Give a man a sword and tell him he’s defending the cross, and there’s no end to the damage he can do.
There’s also a theological objection to the idea that right deserves might. In Christian theology, Jesus was both God and man, a person without sin. I’m fallen and flawed. He is not.
And how did this singular individual — this eternal being made flesh — approach power? He rejected it . . . . Christ’s words were clear, and they cut against every human instinct of ambition and pride:
“The last will be first.”
“It is easier for a camel to go through the eye of a needle than for a rich man to enter the kingdom of God.”
“If any man would come after me, let him deny himself and take up his cross and follow me.”
“Love your enemies and pray for those who persecute you.”
Those were the words. The deeds were just as clear. He didn’t just experience a humble birth; Jesus was raised in a humble home, far from the corridors of power. As a child, he was a refugee.
And when he began his ministry, he constantly behaved in a way that confounded every modern understanding about how to build a movement, much less how to overthrow an empire.
He withdrew from crowds. When he performed miracles, he frequently told the people he healed not to tell anyone else. When he declared, near the end of his life, that we are to “render therefore to Caesar the things that are Caesar’s, and to God the things that are God’s,” he not only rejected the idea that he was Caesar, he also rejected the idea that Caesar’s domain was limitless.
It’s remarkable how often ambition becomes cruelty. In our self-delusion, we persuade ourselves that we’re not just right but that we’re so clearly right that opposition has to be rooted in arrogance and evil. We lash out. We seek to silence and destroy our enemies.
But it is all for the public good. So we sleep well at night. We become one of the most dangerous kinds of people — a cruel person with a clean conscience.
The way of Christ, by contrast, forecloses cruelty. It requires compassion. It inverts our moral compass, or at least it should. We love rags-to-riches stories, for example, so if many of us were writing Christ’s story, we might begin with a manger, but we’d end with a throne.
But Christ’s life began in a manger, and it ended on a cross. He warned his followers that a cross could come for them as well. An upside-down kingdom began with an upside-down birth. When Jesus himself is humble, how do we justify our pride?
I - and my extended family - have largely walked away from organized religion. It has taken me years to recover from the damage of my Catholic upbringing. I most certainly do not want my grandchildren to suffer what I endured. I suspect I am far from alone in this feeling.
Saturday, December 21, 2024
Trump and the GOP Dig Up “Zombie Laws”
During Donald Trump’s first term, courts provided a necessary check on his ambitions by blocking many of his deregulation efforts, on issues ranging from the environment to immigration, along with his initial version of a travel ban targeting Muslim-majority countries. Even the Supreme Court, which has empowered Trump in a number of ways, prevented him from dismantling DACA.
This time around, to avoid such pesky checks and balances, Trump and his allies have revisited US history and found some truly heinous old laws to advance their right-wing agenda. These “zombie laws,” as they’re called, are provisions that haven’t been enforced or invoked for decades but are somehow still on the books. Yet they could be resurrected in a radical fashion if and when Project 2025 becomes America’s reality.
Arguably the worst among them is the Comstock Act of 1873, a product of the Victorian-era moral panic named after anti-vice activist Anthony Comstock. It was designed to restrict the distribution of “obscenities” at the time, like pornography, contraceptives, and even some medical textbooks. Despite its anachronous nature, the Comstock Act has never been repealed. And earlier this year, during oral arguments for FDA v. Alliance for Hippocratic Medicine—which centered on the agency’s approval of mifepristone, an abortion medication often ordered by mail—justices Clarence Thomas and Samuel Alito mused on the idea of bringing the law back to life.
Of course, the Comstock Act is some “obscure law,” whose enforcement, The American Prospect notes, essentially stopped in the 1930s, after federal courts clarified that it could only be applied when someone was mailing an item or drug specifically intended to be used illegally for an abortion. The law had been largely dormant for decades, until Trump appointed Amarillo, Texas, district judge and anti-choice zealot Matthew Kacsmaryk, who used it to try to take the abortion pill off the market. “We don’t need a federal ban when we have Comstock on the books,” as Jonathan F. Mitchell, who has worked as a lawyer for Trump, told The New York Times.
[M]ore to Mitchell’s point is the fact that the Comstock Act might allow Trump to circumvent congressional approval. “Abortion opponents are turning to laws like the Comstock Act,” as legal scholar Mary Ziegler told me in an email, “because they doubt that even a Republican Congress would pass a sweeping ban that voters today would never accept.” The GOP could presumably shut down the mailing of abortion pills without incurring the poor optics of a federal ban; it could also claim that it brought the issue “back to the states,” even while using a federal law to negate states’ laws. Still, the larger question remains: Why was Comstock even allowed to stay on the books in the first place? And why didn’t Democrats ever make a concerted effort to repeal it earlier?
Aside from the Comstock Act, the other zombie law in contention is the Alien and Sedition Acts of 1798. The acts, passed by a Congress in the control of Alexander Hamilton’s Federalist Party, tightened restrictions on anti-government speech and gave the government power over immigrants deemed threats to the country. One of them, the Alien Enemies Act—which allows the federal government to relocate foreign nationals from countries deemed hostile to the United States during times of war—has only been invoked on three occasions. It was used by James Madison against the British during the War of 1812; by Woodrow Wilson during World War I to send more than 6,000 people, many of whom were German, to internment camps; and by Franklin D. Roosevelt during World War II, which led to the internment of Japanese citizens.
But now Republicans are angling to use it again, to create a legal framework for the mass internment and deportation of immigrants—perhaps the biggest promise of Trump’s campaign. The president-elect has repeatedly said that the residence of some 11 million undocumented immigrants in America constitutes a foreign “invasion”—incidentally a precondition for the law’s enforcement. The problem, though, is that Republicans need to prove that America is genuinely at war—which it isn’t, rendering their theory completely faulty. Nevertheless, the end result of Trump’s immigration platform might look a lot like the Dwight Eisenhower administration’s 1954 “Operation Wetback,” in which law enforcement used military-style tactics to forcibly remove hundreds of thousands of Mexican immigrants from the US.
Zombie laws may just be theoretical legal frameworks on a piece of paper. But they are also products of some of America’s most objectionable policymaking. Remember: America was the home of Jim Crow laws—which were the inspiration for the Nuremberg Laws. The Comstock Act and Alien and Sedition Acts were used during a time when American legislators were motivated by entrenched racism and sexism, writing immoral laws that masqueraded as moral.
The reason Trumpworld needs to use these laws is because its ideas are profoundly antiquated. Sure, Trump narrowly won this election. But no matter how mad Americans may be about inflation, no one is signing up for a return to the Victorian era.
Friday, December 20, 2024
Thursday, December 19, 2024
Trump to Russia's Rescue
Dictatorships seem stable and almost invulnerable, until the day they fall. Syrian President Bashar al-Assad’s regime crumbled in days in the face of an offensive led by Hayat Tahrir al-Sham, or HTS, a group that the United States considers a terrorist organization. But the Syrian civil war is, for now, mostly over. Hundreds of thousands are dead.
I wrote more than a decade ago in favor of Western intervention in Syria, back when the butcher’s bill was still in the tens of thousands, and finally gave up when Assad repeatedly used chemical weapons and got away with it. I predicted at the time that President Barack Obama’s decision against military action would undermine America’s position in the Middle East, embolden Iran, and give Russia its first major outpost in the region. Some of my worst fears, sadly, came true, while bodies piled up in the Syrian rubble for the next decade.
I would not even begin to predict Syria’s future, but I can identify one of the biggest losers (besides Assad, of course) now that this nightmare is over: Vladimir Putin.
That is, unless Donald Trump rides to his rescue.
Syria was a symbol of Russia’s desire to return to superpower status, a perch in the Middle East that even Putin’s Soviet predecessors never achieved. It’s hard to overestimate the value of such a position—close to the West’s energy resources and important waterways—to any Russian government, past or present.
As Russia’s geopolitical position in Syria has collapsed, Putin’s prestige and credibility have taken a serious hit. Putin has long prided himself on being an ally who never cuts and runs. . . . . “In the Middle East, Putin has often contrasted the fecklessness of American presidents with his steadfast support to those he views as Russia’s loyal partners. He has marketed this consistency as a selling point as to why he is a better mediator for regional disputes.”
Putin, however, helped seal Assad’s fate when Russia invaded Ukraine, dividing Russian attention and capabilities so badly that when HTS and other rebels launched their offensives, Moscow was unable to offer much help. Now the world has seen Assad chased from his own palace while Putin did nothing, a spectacle that casts doubt both on Putin’s power and on the value of his word.
Putin is also in other jams of his own making. The Russian economy is suffering from sanctions and from the costs of his military adventure in Ukraine. On the ground in Ukraine, his troops are advancing slowly through a meat grinder in a war that was supposed to be over in a week. North Koreans are fighting alongside Russians, and a senior Russian military officer was blown up in the streets of Moscow. The sprawling Russian Federation now looks like a banana republic that needs assistance from Pyongyang’s hermit kingdom and can’t even keep one of its own generals safe in the national capital.
Putin’s very bad year could be a very good opportunity for the West and for the besieged Ukrainians, if the Americans and their allies continue to strain Russia’s military on the battlefield and Russia’s economy in the global marketplace—in other words, if someone other than Trump were about to become the leader of the free world.
Trump openly admires Putin, and has reportedly spoken with him multiple times since leaving the White House in 2021. He is unlikely to press the West’s advantage.
And what exactly would Trump do differently? During his campaign, Trump said he could end the war in a day. Now he says that the war is “a tough one; it’s a nasty one,” with people “being killed at levels that nobody’s ever seen.” (Fact check: People have been killed at such levels in many modern wars, but it’s to Trump’s credit if he’s concerned.) Trump claims to want a peace deal; the problem is that in practice, any “peace deal” means letting Putin keep his imperial acquisitions while he gears up for renewed fighting.
Trump has named retired General Keith Kellogg as his special envoy for Ukraine and Russia. Kellogg (who accepts the risible Russian line that the war was spurred in part by Moscow’s fears that Ukraine would join NATO) has argued for continuing to arm Ukraine if Russia won’t agree to a cease-fire. This might seem a hard line, but it’s pure theater: Putin knows this game, and he will simply repeat his Crimea playbook from 2014 and 2015, agreeing to peace negotiations while engaging in chicanery and cease-fire violations behind the scenes. The weapons to Ukraine will dry up, the West will look away in shame, and Putin’s tanks will roll again as soon as he’s caught his breath.
I hope I’m wrong and that wiser heads prevail on Trump to take advantage of Putin’s misfortunes. . . . . More likely, Trump will go on with his campaign of retribution at home while the Russians do as they please.
Events in Syria have opened a historic opportunity, but sometimes the man and the moment do not meet.
Wednesday, December 18, 2024
Tuesday, December 17, 2024
Trump and The Great Capitulation
At a press conference at Mar-a-Lago on Monday, Donald Trump described recent visits from Tim Cook, C.E.O. of Apple, Sergey Brin, a co-founder of Google, and other tech barons. “In the first term, everyone was fighting me,” he said. “In this term, everyone wants to be my friend.” For once, he wasn’t exaggerating.
Since Trump won re-election — this time with the popular vote — many of the most influential people in America seem to have lost any will to stand up to him as he goes about transforming America into the sort of authoritarian oligarchy he admires. Call it the Great Capitulation.
Following Jan. 6, Mark Zuckerberg, the Facebook co-founder, suspended Trump’s account. But last month at Mar-a-Lago, The Wall Street Journal reported, Zuckerberg stood, hand on heart, as “the club played a rendition of the national anthem sung by imprisoned” Jan. 6 defendants. (It’s not clear if Zuckerberg knew what he was listening to.) He’s pledged a million-dollar donation to Trump’s inauguration, as did the OpenAI C.E.O. Sam Altman and Jeff Bezos’ company Amazon, which will also stream the inauguration on its video platform.
After Time magazine declared Trump “Person of the Year,” the publication’s owner, the Salesforce C.E.O. Marc Benioff, wrote on X, “This marks a time of great promise for our nation.” The owner of The L.A. Times, the billionaire pharmaceutical and biomedical entrepreneur Patrick Soon-Shiong, killed an editorial criticizing Trump’s cabinet picks and urging the Senate not to allow recess appointments.
Most shocking of all, last week ABC News, which is owned by the Walt Disney Company, made the craven decision to settle a flimsy defamation case brought by Trump.
As you may remember, a jury last year found Trump civilly liable for sexually abusing the writer E. Jean Carroll. In a memorandum, the judge in the case explained that while a jury didn’t find that Trump had raped Carroll, it was operating under New York criminal law, which defines rape solely as “vaginal penetration by a penis.” It did find that he’d forcibly penetrated her with his fingers.
“The finding that Ms. Carroll failed to prove that she was ‘raped’ within the meaning of the New York Penal Law does not mean that she failed to prove that Mr. Trump ‘raped’ her as many people commonly understand the word ‘rape,’” wrote the judge. “Indeed, as the evidence at trial recounted below makes clear, the jury found that Mr. Trump in fact did exactly that.”
The ABC News anchor George Stephanopoulos appeared to be using this broader definition when, in March, he said on-air that a jury had found Trump “liable for rape.” Trump, who regularly threatens, and sometimes files, defamation cases against his perceived enemies in the press, sued. And though his case seemed absurdly weak, ABC News decided to settle in exchange for a $15 million donation to Trump’s future presidential library or museum, $1 million in legal fees and a public statement of regret from Stephanopoulos and the network.
Displays of submission aren’t limited to tech and media. Christopher Wray, the head of the F.B.I., agreed to step aside before the end of his 10-year term rather than make Trump fire him.
Different people have different reasons for falling in line. Some may simply lack the stomach for a fight or feel, not unreasonably, that it’s futile. Our tech overlords, however liberal they once appeared, seem to welcome the new order. Many hated wokeness, resented the demands of newly uppity employees and chafed at attempts by Joe Biden’s administration to regulate crypto and A.I., two industries with the potential to cause deep and lasting social harm. There are C.E.O.s who got where they are by riding the zeitgeist; they can pivot easily from mouthing platitudes about racial equity to slapping on a red MAGA hat.
Some Democrats appear to think that they might steer DOGE in a productive direction and that, regardless, they’ll get credit for bipartisanship.
One of Kamala Harris’s pollsters, Politico reported, recently warned the Democratic National Committee leadership against pearl-clutching over Trump’s transgressions, including the wildly unfit characters he’s announced for his administration. The voters, she said, “don’t care about who he’s putting in cabinet positions.”
Collectively, all these elite decisions to bow to Trump make it feel like the air is going out of the old liberal order.
“The individual has the intrinsic moral right to live his life in a special and fulfilling way without subordinating to the universal collective,” Marc Andreessen, the software engineer and venture capitalist at the forefront of Silicon Valley’s rightward lurch, wrote on X last week. “Purveyors of abstract guilt must not steal that from you.” Even powerful people who didn’t vote in favor of this harsh new world can find their consolations in it.
Monday, December 16, 2024
Sunday, December 15, 2024
Kash Patel - A Dangerous Ideologue
Some key pieces appear to be snapping neatly into place for Donald Trump’s much-feared prosecutorial revenge tour as the year draws to a close.
Trump’s new nominee to lead the Justice Department, Pam Bondi, is a staunch loyalist who predicted last year that after Trump’s reelection, “the prosecutors will be prosecuted — the bad ones.”
And his plan to install Kash Patel as FBI director was made easier after Christopher Wray, himself a Trump appointee, . . . . has proven particularly controversial, since his principal qualification appears to be his sycophancy toward Trump. (A Trump transition spokesperson said, “Kash Patel has served in key national security positions throughout the government. He is beyond qualified to lead the FBI and will make a fantastic director.”)
Many observers, including former federal law enforcement officials, oppose Patel’s nomination on the grounds that he would likely use the FBI to pursue Trump’s political opponents and that he might substantially corrupt the culture and professionalism of the bureau. To some, Patel calls to mind the specter of J. Edgar Hoover, the infamous FBI director whose nearly 50-year stint running the agency until 1972 was marked by egregious abuses of power — including illegal surveillance, blackmail and the harassment of political dissidents. Patel clearly lacks the qualifications, experience and temperament to lead the agency. But how worried should the American public really be about him at the helm of the FBI? . . . He will indeed face some constraints because of the culture and bureaucracy of the FBI. But they may not contain him. And he will have plenty of opportunity to damage the bureau and its work — and to use and abuse the FBI for political ends. His nomination poses a considerable and unjustifiable risk to the country.
On paper, there is no way to justify Patel’s ascension. He spent a few years as a federal prosecutor focused on national security and was an aide in Congress and the first Trump administration on intelligence and national security issues. Even setting aside the decidedly mixed and often controversial results of that work (more on that below), Patel has no experience managing anything remotely like the FBI’s sprawling bureaucracy — 35,000 employees, 55 field offices throughout the country and more than 60 offices overseas.
What he does have is years spent endorsing Trump’s conspiracy theories and railing against many of Trump’s perceived enemies in the “deep state” — often in deeply unserious appearances on Steve Bannon’s War Room podcast, on other conservative media outlets and on the campaign trail.
Those appearances — replete with comments from Patel that would disqualify him from consideration for the post in pretty much any other era — have since become a central part of the case against him.
He has frequently denigrated the employees he hopes to lead — perhaps most infamously, when he said he would “shut down the FBI Hoover Building on day one and reopen [it] the next day as a museum of the deep state” and “take the 7,000 employees that work in that building and send them across America to chase down criminals.” He has accused the FBI and Justice Department of “politicizing targets and manufacturing crimes” and questioned “how Americans can have any faith in this FBI anymore.” . . . . he describes the FBI as “an existential threat to our republican form of government.”
The fear that Patel would use the FBI to go after Trump’s political opponents is also well-founded given Patel’s own public statements. Perhaps most notably, he has threatened to “go out and find the conspirators, not just in government but in the media … who lied about American citizens, who helped Joe Biden rig presidential elections.” He added, “Whether it’s criminally or civilly, we’ll figure that out. But yeah, we’re putting you all on notice.”
Patel has also previously publicly zeroed in on some of Trump’s most prominent antagonists. Among others, he has suggested that Attorney General Merrick Garland, Manhattan DA Alvin Bragg and Anthony Fauci should be investigated or potentially arrested. So far as I can tell from the rhetoric, the legal theories underlying Patel’s claims are at best highly dubious, if not transparently ridiculous.
Despite these sorts of guardrails, the risks of Patel’s nomination remain real.
For one thing — and it is no small thing — many of Patel’s former colleagues in the first Trump administration describe him as dishonest and unsuited for a top law enforcement post.
“He’s absolutely unqualified for this job. He’s untrustworthy,” Charles Kupperman, Trump’s deputy national security adviser and Patel’s former supervisor, recently told The Wall Street Journal. “It’s an absolute disgrace to American citizens to even consider an individual of this nature,” he said.
During Trump’s first term, former Attorney General William Barr blocked Patel’s appointment by Trump to serve as deputy FBI director. “Patel had virtually no experience that would qualify him to serve at the highest level of the world’s preeminent law enforcement agency,” Barr wrote in his book. Likewise, when Trump considered installing Patel as the deputy CIA director during his first term, Gina Haspel, who was then leading the agency, reportedly threatened to resign. Another former Trump DOJ official who worked with Patel recently described the prospect of him running the bureau as “terrifying.” Again, these aren’t liberal activists: They are Trump officials.
There is also opportunity for abuse even in ostensibly straightforward areas, notwithstanding the legal and bureaucratic constraints on the FBI director.
It would be an extraordinary — but not necessarily shocking — move, but Patel could waive the DIOG requirements and order investigations despite the requirements and procedures laid out in bureau guidelines. Patel could also recruit politically sympathetic FBI agents and prosecutors to help on particularly controversial or dubious cases. The process would likely be easier with the help of Bondi at the Justice Department.
Patel would also be empowered to punish agents who worked on cases that he disfavors on political grounds — like the Trump prosecutions and cases targeting far-right extremists.
It is also possible to start dubious investigations and to then try to trip people up based on alleged process crimes — like lying to the FBI — even if there was no underlying misconduct to begin with. Here too, we saw troubling precursors during the first Trump administration. . . .
There’s one other, perhaps unlikely, episode from the first Trump administration to draw on when thinking about Patel: the family separation saga.
Trump officials at the time tried to implement an illegal and immoral crackdown at the southern border, and they were aided by federal agents and prosecutors. The effort ultimately came to a halt after bureaucratic chaos, public blowback and a ruling from a federal judge, but in the relatively short period of time during which the policy was in place, the government managed to separate over 5,000 children from their families, inflicting incalculable harm on them in the process. Hundreds of them have still not been reunited.
There is a grim but essential lesson here as the Senate weighs Patel’s nomination to lead America’s top law enforcement agency: Malicious and powerful government officials can cause incredible harm — even if they are incompetent, and even if they are eventually stopped.
Saturday, December 14, 2024
Trump Is About to Betray His Rural Supporters
Donald Trump’s support in rural America appears to have virtually no ceiling. In last month’s election, Trump won country communities by even larger margins than he did in his 2020 and 2016 presidential runs. But several core second-term policies that Trump and the Republican Congress have championed could disproportionately harm those places.
Agricultural producers could face worse losses than any other economic sector from Trump’s plans to impose sweeping tariffs on imports and to undertake what he frequently has called “the largest domestic deportation operation” of undocumented immigrants “in American history.” Hospitals and other health providers in rural areas could face the greatest strain from proposals Trump has embraced to slash spending on Medicaid, which provides coverage to a greater share of adults in smaller communities than in large metropolitan areas. And small-town public schools would likely be destabilized even more than urban school districts if Trump succeeds in his pledge to expand “school choice” by providing parents with vouchers to send their kids to private schools.
Still, the most likely scenario is that elected Republicans who represent rural areas will ultimately fall in line with Trump’s blueprint. If so, the effects will test whether anything can loosen the GOP’s grip on small-town America during the Trump era, or whether the fervor of his rural supporters provides Trump nearly unlimited leeway to work against their economic interests without paying any political price.
“I don’t think [the Trump agenda] is going to lead to a dramatic reversal of these partisan shifts, because the truth is that the disdain for the Democratic Party is decades in the making and deep in rural America,” Nicholas Jacobs, a political scientist at Colby College . . . . . But if Trump acts on the policies he campaigned on, Jacobs added, “it’s hard to imagine that rural [places] will not suffer and will not hurt, and it’s hard to imagine that rural will not respond.”
Across his three runs for the White House, Trump gained considerably more support in the most-rural counties than in the nation’s more populous communities. Although he ran no better in the most-urban counties than did the 2012 Republican nominee, Mitt Romney, Trump roughly doubled the GOP margin in nonmetro areas from 20 points in 2012 to nearly 40 this year.
Congressional elections have largely followed the same trajectory. . . . Maps of party control of House seats now show the countryside solidly red in almost every state. Barring a few exceptions in New England, the states where rural residents compose the largest share of the population preponderantly elect Republicans to the Senate as well.
As Jacobs noted, the GOP advances in small-town America feed on these communities’ deep sense of being left behind in a changing America. . . . After years of seemingly inexorable decline in more remote communities, Jacobs believes, rural residents are especially responsive to Trump’s attacks on “elites” and his promises to upend the system. “I think rural people are rejecting the idea that the devil we know is worse than the devil Trump may bring,” Jacobs told me.
Despite the appeal of Trump’s promise of “retribution” against the forces these people believe have held them back, the change he’s offering in the specifics of his second-term agenda may strain those ties. The potential conflicts begin with Trump’s plans for trade. Agricultural producers faced the most turmoil from the tariffs that Trump in his first term . . . . Trump bought peace with farm interests by disbursing more than $60 billion in payments to producers to compensate for the markets they lost when China and other countries imposed retaliatory tariffs on U.S. products such as soybeans, corn, and pork. Those payments consumed nearly all of the revenue that Trump’s tariffs raised. . . .
Trump’s payments to farmers preempted any large-scale rural revolt during his first term. But they nonetheless imposed long-term costs on agricultural producers.
The bruising trade conflicts of Trump’s first term encouraged foreign purchasers of American farm products to diversify their supply in order to be less vulnerable to future trade disruptions, . . . . the United States lost share in those markets and never recovered it. In 2016, for example, the U.S. sold nearly as many soybeans to China as Brazil did; now Brazil controls three times as much of the Chinese market. . . . that means we left a lot of money on the table.”
He’s now threatening much more sweeping levies, including a 10 percent tariff on all imports, rising to 60 percent on those from China and 25 percent for goods from Mexico and Canada. Steinbach believes farmers will “very likely” now face even greater retaliatory trade barriers against their produce than they did in Trump’s first term. “The worst-case scenarios are really bad,” he told me.
Farm lobbies are welcoming Trump’s pledge to slash environmental regulations and hoping that he can deliver on his promise to cut energy costs. But his determination to carry out the mass deportation of undocumented immigrants will create another challenge for farmers. Agriculture relies on those workers as much as any other industry . . . . Removing a significant share of those workers through deportation, Steinbach said, would further erode the international competitiveness of American farmers by raising their labor costs and thus the price of their products.
Eliminating undocumented workers would also put upward pressure on domestic food prices—after an election that, as Trump himself noted, he won largely because of the price of groceries—and would also weaken rural economies by removing those workers’ buying power.
A recent attempt to model how Trump’s tariff and mass-deportation plans would affect agricultural producers found a devastating combined impact. In a scenario where Trump both imposes the tariffs he’s threatened and succeeds at deporting a large number of immigrants, the nonpartisan Peterson Institute for International Economics has forecast that by 2028, agricultural exports could fall by nearly half and total agricultural output would decline by a sixth.
Equally painful for rural America could be Trump and congressional Republicans’ agenda for health care. . . . . Retrenching federal spending on Medicaid and the ACA remains a priority for congressional Republicans. . . . . The Republican Study Committee, a prominent organization of House conservatives, called in its latest proposed budget for converting Medicaid and ACA subsidies into block grants to states and then cutting them by $4.5 trillion over the next decade . . . . Larry Levitt, the executive vice president for health policy at the nonpartisan KFF think tank, told me. “We are looking at cutting tens of millions of people off from coverage.”
Rural places would be especially vulnerable to cuts anywhere near the level that Republicans are discussing. Rural residents tend to be older and poorer, and face more chronic health problems. Rural employers are less likely to offer health insurance, which means that Medicaid provides coverage for a larger share of working-age adults in small towns. . . .
Medicaid is especially important in confronting two health-care challenges particularly acute in rural communities. One is the opioid epidemic. . . . . Medicaid has become the foundation of the public-health response to that challenge. . . . Hundreds of thousands of people are receiving opioid-addiction treatment under Medicaid in heartland states that Trump won, such as Michigan, Pennsylvania, Ohio, Kentucky, and Indiana. In all of those states, a majority of people receiving care are covered through the Medicaid expansion . . . .
Medicaid is also a linchpin in the struggle to preserve rural hospitals. These face much more financial stress than medical facilities in more populous areas. Mann says that over the past two decades, 190 rural hospitals have closed or converted to other purposes, and nearly a third of the remaining facilities show signs of financial difficulty.
That situation makes Medicaid a crucial lifeline for rural hospitals. “With large cuts to federal health spending, it would be very hard for rural health-care providers to simply survive,” said the KFF’s Levitt. “In many cases, rural hospitals are hanging by a thread already, and it wouldn’t take much to push them over the edge.”
In the same way that rural hospitals are especially vulnerable to Trump’s health-care agenda, his education plans could threaten another pillar of small-town life: public schools. Trump has repeatedly promised to pursue a nationwide federal voucher system that would provide parents with public funds to send their children to private schools. . . . . Small-town residents, she said, recognized that rural public schools already facing financial strain from stagnant or shrinking enrollments have little cushion if vouchers drain more of their funding. Regardless of how receptive conservative rural voters might be to Republican attacks on “woke” educators, Coots noted, “if you ask them about their public school or their neighborhood school, they like it, because they know what the public school means for their community.”
Friday, December 13, 2024
American's Health Care System: Driven By Profit, Not Patient Care
In 2010, a private-equity firm called Cerberus Capital Management, which is named for the three-headed dog that is said to guard the underworld, bought six Catholic hospitals in Massachusetts and christened the chain Steward Health Care. The state’s attorney general blessed the deal on multiple conditions, including that, during a five-year review period, the hospitals stayed open and their workers stayed employed. A few months after the period ended, however, Steward started selling the land on which the hospitals stood. A $1.25-billion-dollar deal, in 2016, helped to finance more acquisitions. Many facilities, asked to pay rent on land they’d previously owned, struggled.
According to a recent report published by Massachusetts Senator Ed Markey’s office, which covers the period between 2017 and 2024, some Steward facilities had to forgo key investments in staffing, surgical equipment, elevator repairs, and even clean linens. Patients increasingly languished in emergency rooms; many left without receiving care; and mortality rates for common conditions climbed sharply. . . . . A hospital in Florida developed a bat infestation, and another, in Texas, was cited for placing potentially suicidal patients in rooms with materials with which they could hang themselves. Employees at Steward’s Carney Hospital, in Massachusetts, began calling their workplace “Carnage” hospital.
In May, Steward filed for bankruptcy. It has closed two hospitals and plans to sell thirty-one others. Steward’s C.E.O., Ralph de la Torre, who in 2011 purchased a forty-million-dollar superyacht, was subpoenaed by a Senate committee but failed to show up; he was held in contempt of Congress and resigned from his position. . . . . Nonetheless, Cerberus realized a profit of seven hundred and ninety million dollars from its investment in Steward.
Meanwhile, in some places in the U.S., private-equity firms now own more than half of all medical practices within certain specialties. “We are being picked clean by private equity,” a New Jersey-based radiologist said at a recent meeting of the American Medical Association.
2024 was arguably the year that the mortal dangers of corporate medicine finally became undeniable and inescapable. A study published in JAMA found that, after hospitals were acquired by private-equity firms, Medicare patients were more likely to suffer falls and contract bloodstream infections; another study found that if private equity acquired a nursing home its residents became eleven per cent more likely to die. Although private-equity firms often argue that they infuse hospitals with capital, a recent analysis found that hospital assets tend to decrease after acquisition. Yet P.E. now oversees nearly a third of staffing in U.S. emergency departments and owns more than four hundred and fifty hospitals.
Erin Fuse Brown, a professor at the Brown University School of Public Health, told me that private-equity firms have learned that they “don’t have to make things better or make them more efficient. You can just change one small thing and make a ton more money.” They are hardly the only corporations to learn this lesson. Increasingly, health insurers, private hospitals, and even nonprofits are behaving as though they aim first to extract revenue, and only second to care for people. Patients often are viewed less as humans in need of care than consumers who generate profit.
In 1873, Mark Twain co-wrote the novel “The Gilded Age: A Tale of Today,” which satirized an era that was marked by inequality, greed, and moral decay but was painted in a veneer of abundance and progress.
New technologies and treatments sustain the impression that patients have never been healthier, but corporations and conglomerates wield immense power at the expense of the people they’re meant to serve. Welcome to the Gilded Age of medicine.
In recent years, health-care corporations have embraced an approach that can only be described as gamification. In the U.S., all seniors over sixty-five are entitled to health insurance through Medicare, and, for several decades, private companies have offered plans through programs such as Medicare Advantage. The government pays insurance companies a fixed sum based partly on how sick those patients are. The sicker the patients, the bigger the potential payments. But who’s to say, really, how sick a patient is? Let the games begin.
This year, the health-news site STAT revealed that UnitedHealth, the country’s largest private insurer, had set up dashboards for practices to compete on how many conditions they could diagnose in patients. Doctors who completed the most appointments with seniors in Medicare Advantage were eligible for ten-thousand-dollar bonuses, and patients were offered seventy-five-dollar gift cards for getting checkups at which their medical histories could be recorded.
These strategies rack up so many additional diagnoses that, in 2023 alone, the federal government made $7.5 billion in “overpayments” to insurers, according to the U.S. Office of the Inspector General. Insurers are “pouring tremendous resources into developing the capacity to code patients in a way that nets more money from Medicare,” Donald Berwick, a former head of the Center for Medicare & Medicaid Services, told me. “That’s taxpayer money being siphoned away from people who need it.”
Berwick said that his own physician’s practice had recently been acquired by UnitedHealth. One day, he asked his doctor, “Anything different now?” “Two things,” the doctor replied. “I have to see more patients each day. And my patients have new diagnoses that I didn’t put there.” . . . . It did, however, generate higher payments from Medicare. Ask not what your insurer can do for you—ask how much revenue you can generate for your insurer.
The insurance companies in Medicare Advantage tend to argue that they’re simply recording diagnoses, not making them up . . . . But according to the Medicare Payment Advisory Commission, a nonpartisan agency that counsels Congress, private Medicare Advantage plans will cost the federal government eighty billion dollars more per year than if those patients had been in the traditional Medicare program. “You might as well flush most of that eighty billion dollars down the toilet,” Berwick told me.
On December 4th, after I drafted this piece, Brian Thompson, the C.E.O. of UnitedHealthcare, was fatally shot in midtown Manhattan. In the days that followed, the public response was not just one of shock but also of frustration and even rage against the health-insurance industry. . . . . Thompson had become a symbol of a broken system; people who devalued his life, it seemed to me, were engaging in a version of the dehumanizing behavior that they found objectionable within the health-care industry.
It would be nice if nonprofit health care were the antidote to corporate health care. Instead, each year, it seems to look more like for-profit medicine. The Times recently reported that Providence, one of the nation’s largest not-for-profit health-care organizations, sicced debt collectors on poor patients who were entitled to free care. Providence, which was founded in the eighteen-fifties by nuns committed to “serving all, especially those who are poor and vulnerable,” recorded annual revenues in excess of twenty-seven billion dollars in 2021. Like other nonprofits, it benefitted from enormous tax breaks, yet only one per cent of its expenses went to charity care. . . . . other hospitals still have policies of suing patients, obtaining court orders to garnish their wages if they fail to pay, and even placing liens on their homes.
Meanwhile, an increasingly consolidated health-care industry has engendered the kinds of too-big-to-fail behemoths that can single-handedly paralyze the system. Health care accounts for more than seventeen per cent of the U.S. economy, or around four and a half trillion dollars, but the revenues of just two companies—CVS/Aetna and UnitedHealth—account for nearly one in every seven dollars the nation spends on health care.
It’s not that any talk of money should be rejected—hospitals and clinics need to keep the lights on, after all. But we need counternarratives to revive medicine’s social contract and to help curb the kind of financial gamesmanship that has become accepted and pervasive.
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