The political and religious musings of a Right-leaning, libertarian, formerly Orthodox Jew who emphasizes rationalism, pragmatism, common sense, and free, open-minded thought.
While there have been a number of controversial Supreme Court cases over the years, few have caused such controversy in modern times as Citizens United v. Federal Election Commission (FEC), or simply "Citizens United." This ordeal started when a non-profit, Citizens United, wanted to air a film critical of Hillary Clinton during the 2008 elections. Before airing the movie, Citizens United approached the FEC. The FEC denied the request, arguing that such a film would be in violation of §203 of the Bipartisan Campaign Reform, better known as the McCain-Feingold Act. This Section prohibited an "electioneering communication" 60 days prior to a general election of 30 days prior to a primary election. The U.S. District Court of the District of Columbia ruled in favor of the FEC. The case made its way to the Supreme Court, at which point the U.S. Supreme Court ruled 5-4 on January 21, 2010 that the Free Speech clause of the First Amendment prohibits the restriction of independent expenditures allocated towards political communications by corporations (including non-profit ones), labor unions, and other associations. Since then, Citizens United has become a symbol on the Left for everything that is wrong with political campaigning in the United States.
Before jumping into the impact of Citizens United, it's worth noting that Citizens United did not allow for corporate donations to campaigns. The Tillman Act of 1907 still bans those donations. Citizens United reversed a ban on independent expenditures from corporations that was ruled on in Austin v. Michigan Chamber of Commerce. Also, individuals also can spend an unlimited amount of money on political campaigns (Buckley v. Valeo). Citizens United did not impact laws regarding individual or corporate contributions to political campaigns.
That being said, I have to wonder whether Citizens United truly messed with political campaigning in the United States. This is a tricky question to answer not only because there have not been enough election cycles to make more conclusive statements, but also because of the nature of these political action committees [PAC], which are known as Super PACs. This is why I look at the influence money has on politics more generally.
Yes, it is true that with the cap removed, the independent expenditures from these Super PACs has increased notably. I also understand that campaigns are won with media, and media requires money. Without money, you de facto could not run for office. The average cost of winning a seat in the House of Representatives in 2016 was $1.6 million, and it's a safe assumption that the vast majority of U.S. citizens do not have that sort of cash lying around. It is also true that as of the 2016 election, more than 90 percent of candidates that outspent their opponents won.
However, correlation is not the same thing as causation. It is generally found that "political expenditures are rarely pivotal in determining election outcomes (Barutt and Schoenfeld, 2016)." Incumbents tend not to benefit from spending more money (ibid.). When it comes to challengers, the historical evidence has been less clear (Levitt, 1994) because incumbents already have name recognition and free media. Whether a challenger can upend that incumbency can be tricky, but if successfully done, the challenger gets a greater bang for their buck. Television advertisements are shown to have a strong, but short-lived and easily forgotten effect on voting preferences (Gerber et al., 2011). Advertising seems to have its best effects when the candidate is not already well-known and if it is less predetermined by partisan lines. In short, that spending works if voters are not previously aware of a candidate, after which the campaign spending has significant marginal rates of return.
It is not simply the limited influence that money has on an election that has me skeptical about Citizens United being a poor ruling for a few reasons.
According to Stanford political scientist Adam Bonica, money has less of an effect in our increasingly partisan society because people are more likely to vote along party lines.
It makes more sense for a corporation to spend money on lobbyists to influence politicians already in office than it does to contribute money indirectly towards political communications during elections.
Removing limits on independent political speech is a good thing, not just from a First Amendment standpoint. It has allowed for a greater diversity of candidates that we would not have otherwise been aware of, as can be observed both from the 2016 Republican primary and the 2020 Democratic primary.
The desire for political power is strong enough that even if there were a reversal of Citizens United, those with money would simply find other means to channel the political funds. After all, that is how the CIO-PAC, which is the first political action committee started up by the labor union AFL-CIO, was founded as a workaround in light of the Tillman Act.
If the issue is with corporations in election media and political campaigning, removing Citizens United as an ultimate solution is odd. Who owns MSNBC? Comcast. Who owns Fox News? Fox Corporation. Who owns the Washington Post? Jeff Bezos, the CEO of Amazon. Going back to the previous point, if a corporation wants to spend in an election, they will find a way. But to reiterate, money only has so much influence in an election.
While corporations are more than happy to lobby, they are unwilling to be particularly partisan. Why? Self-preservation. No good ever came from alienating large swathes of your customer base.
If money were that large of an influence in elections, candidates such as Ross Perot and Michael Bloomberg would have won by now (I don't count Donald Trump into that consideration since Hillary Clinton outspent him in the 2016 elections), but most probably have not because that sort of blatant spending by an individual is not alluring. Self-funded candidates do not have a great track record.
There has been a modest decline in House incumbents that get re-elected since Citizens United.
There has definitely been a shift in political campaigning since Citizens United. Whether it has been good or bad for politics in the United States is still not clear to me, especially given the limited influence of money on election campaigning. It is not as if there were some heyday in the past where elections were completely free of corruption. I also am not prepared to say that Citizens United has been a boon to elections either. In any case, it won't stop partisans from making the usual arguments about Citizens United.
Bernie Sanders really wants Medicare for All to be a reality in the United States. He believes that healthcare should be readily accessible to everyone, and he also believes that the government is the best way to do. I have discussed Medicare for All on this blog in 2016, in 2017, and in 2019. As you can already guess, I am not a fan of government-sponsored healthcare. This week, Sanders made one of his favorite arguments for single-payer healthcare on his Twitter account:
He then links an article from Dylan Matthews over at the Left-leaning Vox that argues how Taiwan's single-payer healthcare system is a success. It makes for a good read if you are looking for an argument in favor of single-payer healthcare and want to use Taiwan as a case study. Essentially, Sanders is arguing that if it can work in Taiwan, it can work here. Let's see a) how well single-payer works in Taiwan, and b) whether we can do it here.
How Well Does Taiwan's Single-Payer System Work?
I actually covered this topic in 2016, but some things merit repeating (not to mention updating for the latest available figures). Let's list some of the merits of the Taiwanese healthcare system first:
Low cost as percent of GDP. In 2017, Taiwan paid 6.4 percent of its GDP in healthcare. This amount is below the OECD average of 8.8 percent, and certainly below the U.S. amount of 17.2 percent of GDP (OECD). Taiwan has also been able to keep its costs steady in terms of spending as a percent of GDP.
Short Waiting Periods. Unlike its counterparts in Canada and the United Kingdom, Taiwan is known for keeping its waiting periods for procedures short. This surely is an important metric for access to medical care.
Comprehensive Coverage. Taiwanese health care provides many services, including inpatient and outpatient care, mental health care, prescription drugs, dental care, Chinese medicine, and dialysis care.
While these are advantages, the Taiwanese healthcare system does come with its limitations:
Yes, there is high patient satisfaction. The same cannot be said for the doctors. Less than half of health care providers are satisfied and the burnout from Taiwanese doctorsis high. In Singapore, a doctor only sees about 20 patients a day. In Taiwan, that number is 80 to 100. As the centrist Brookings Institution brings up in its 2015 analysis, the system is too generous towards patients.
One of the major flaws of the single-payer healthcare system is that demand for healthcare exceeds supply. It means that there needs to be a rationing mechanism to deal with the shortage. For Canada, it is longer waiting times. In the United Kingdom, it means limiting healthcare coverage. Taiwan is able to ration healthcare by keeping consultation timesshorter than average.
As Dylan Matthews brought up in his piece, "Hospitals in Taiwanare crowded. The capacity of health care providers to attend to everyone can be stretched pretty thin."
Since its inception, the Taiwanese healthcare system has struggled with sustainable financing. While it was able to get its deficit spending under control, its surpluses have been on the decline (National Health Insurance Statistics, 2018, p. 129). Plus, there has been pressure in Taiwan to increase the copayments that patients pay because its reserves are expected to be depleted in the next couple of years. An aging Taiwanese population and advancing medical technology will only put upward pressure on healthcare costs.
The single-payer system causes yet another issue: discouragement of new innovations. This is especially true with pharmaceuticals. The low prices that Taiwan sets with its monopsony power gives drug producers (and indeed all healthcare goods producers) a disincentive to sell their products in Taiwan. Without a reimbursement price, there are delays for innovations to reach the Taiwanese market.
Why Single-Payer Wouldn't Work Here
Let's assume that you are okay with a depleting reserve fund, lagging behind in medical advancements, overcrowded hospitals, and disgruntled healthcare providers. For argument's sake, let's assume that the benefits of the Taiwanese system outweigh the costs. The single-payer would not work in the United States, certainly in the Pollyannish view that Sanders is looking at single-payer with his rose-colored glasses.
I took coursework on comparative politics in college, and one of the main lessons was that "what might work in one country might not work in another country." This is showing to be the case with something as complicated and interconnected as healthcare. Taiwan is a small, ethnically homogenous island nation that does not have the geographic size or socioeconomic disparities to contend with that the United States does.
Here is another major difference. Taiwan was still not a democracy in the 1980s. It took some willpower of the people to reach this stage, especially since the healthcare system in Taiwan was so broken. When Taiwan implemented its single-payer system in the 1990s, it was practically starting with a blank slate. It did not have to contend with the interactions and interweaving between the private and public sectors that has created the leviathan of U.S. healthcare.
This leads to another interesting point. Uwe Reinhardt, the economist who helped Taiwan create its single-payer system, said that single-payer should not happen in the United States. The reason is that the doctors have such lobbying power that single-payer could never work in the United States. Taiwan instituted its single-payer when costs were low and the government was able to keep prices artificially low by fiat. It is inconceivable to see the U.S. hospital and insurance lobbies relinquish that sort of power.
If Dylan Matthews' article illustrates anything, it is that a single-payer system comes with great sacrifice and considerable drawbacks. And to think this was in a country that had relatively favorable conditions!
There are issues with the United States healthcare system, and I don't just mean Obamacare. I think about the United States and how there is excessive testing and underutilization of preventative care that is brought on by employer-sponsored insurance, a feature that does not exist in other countries. As I brought up last May, there are a lot of painstaking questions that proponents would have to answer, and that is without considering how the Taiwanese system is so different from the U.S. system.
As much as I think there are issues with the current U.S. healthcare system, I do not think that emulating Taiwan is the way to go when our systems are so different. I can at least take some solace that there is not enough traction for single-payer in this country. What does worry me is that popular opinion is trending in a direction that could bring this unmitigated disaster to the United States.
It might be slightly dated news, but I wanted to comment on it now because I figured that I would start my blogging for 2020 with some controversy. About three weeks ago, J.K. Rowling, who is the well-known author of the Harry Potter series, tweeted something so controversial and allegedly transphobic that people were willing to boycott J.K. Rowling. What exactly did Rowling say that was so terrible?
Dressing as you please, self-identifying the way you want, and wishing people the best hardly seem transphobic. It was the last two lines that were controversial. The controversy is because a) Rowling stated that biological sex exists, and b) Rowling showed support for Maya Forstater with #IStandWithMaya.
Who Is Maya Forstater?
Maya Forstater was a tax policy expert formerly contracted at the U.K.-based Centre for Global Development. Forstater lost her job with the Centre not because of her performance on the job, but because of her beliefs on biological sex were "offensive and exclusionary." Forstater had been advocating in opposition to the Gender Recognition Act, which would allow individuals in the United Kingdom to legally change their gender. Here is one of her tweets that sums up her views:
Forstater believes that transwomen are not really women, and that transmen are not truly men. She essentially believes that men are born male and women are born female, i.e., biological sex is immutable. This has made Forstater a hero among feminists who prioritize fighting for sex-based rights, and she also has become vilified as someone who seemingly denies the existence and experience of trans individuals. Not only did Forstater lose her contract, but an employment tribunal in the United Kingdom upheld the Centre's ruling by deeming Forstater's views as "absolutist," "incompatible with human dignity and the fundamental rights of others," and not protected under Equality Act 2010. Rowling did not agree with the treatment of Forstater, hence her tweet.
Sex versus Gender
In colloquial English, many people use the terms "sex" and "gender" interchangeably. In reality, these are two different concepts. Sex refers an individual's biological sex, whether we refer to the individual's anatomy, reproductive system, or secondary sex characteristics. Gender either refers to social roles based on one's sex or to a personal identification based on an internal awareness.
For most people, their gender matches their biological sex. However, there are a small minority of individuals for whom gender identity does not match their biological sex. This distress and mismatch is clinically known as gender dysphoria. Although it is no longer considered a mental disorder among mainstream clinicians, gender dysphoria is a condition that causes considerable mental anguish. To mitigate the anguish, there is counseling and psychotherapy. For those who want to have their bodies conform more so with their gender identity, hormone replacement therapy (HRT) and gender reassignment surgery are available options.
Time for Some Nuance
Life is complex, and the issues surrounding transgender and transexual individuals are no exception. Fortunately, I found a video from transgender political commentator Blaire White illustrating that point (see above). I also want to make an attempt at nuance within this debate.
A word on hiring and firing practices. Blaire White brought this point up in the YouTube video above. An employer has the prerogative to fire someone whose views with which they do not agree. It is their business, and they can run it as intelligently or idiotically as they like. I also think that it is a stupid reason to fire someone. Forstater's views on biological sex did not impede her job performance or made her less qualified of a tax policy analyst.
Biological sex is almost binary. This is a point where Forstater and I disagree. She views sex as either male or female with nothing in between. I at least acknowledge that about one percent of people are intersex (Intersex Society of North America), i.e., someone born with anatomy and/or reproductive organs that do not fit the standard definition of male or female. Not every individual can be unambiguously be categorized as male or female, but the vast majority of people can be unambiguously classified as biologically male or female. Even for transgender individuals, most still identify with one sex or the other. As Blaire White brought up, "Biological sex exists. Without it, there is no such thing as being trans."
Certain aspects of biological sex are somewhat alterable with technology. Part of Forstater's rigidity on biological sex is that she believes that it cannot be changed (immutable), that regardless of various treatment options for those with gender dysphoria, a man is still a man and a woman is still a woman. Technological advancement has made it possible for physical transitions to happen. HRT and gender reassignment surgery make it possible to change some aspects, most notably hormone levels and some secondary sex characteristics vis-à-vis gender reassignment surgery. In this respect, these procedures arguably render a MTF transgender person to not be "strictly biologically male" anymore, and the same goes for a FTM transgender person being "strictly biologically female." These medical advancements make the binary discussed in the previous bullet point even more of a spectrum, although again, most people still exist on one end of that spectrum. If we argue about this existing on a spectrum as opposed to a binary, there is still the question of where on the spectrum post-op trans individuals end up on that spectrum.
Trans individuals still retain characteristics from their biological sex that de facto keeps their biological sex from birth intact. That which was mentioned in the previous bullet point does not change that other aspects, such as chromosomes and certain secondary sex characteristics and anatomy (e.g., there are FTM transgender people that maintain the reproductive organs in order to give birth), still stay the same, even after HRT and gender reassignment surgery. I discussed this last year when analyzing the fairness of male-to-female transexual (MTF) athletes participating in female sporting events. I concluded that it was unfair because in spite of medical advancements, MTF athletes still retain physical advantages from being born biologically male. None of this even gets into what would happen if a trans individual ceased HRT, which harkens back to biological sex and how the body naturally reacts. Even with these changes and the difficulties that come with the journey, trans individuals ultimately and essentially still retain their biological sex (see point below). This is not a statement about human dignity, but rather about how medical technology has not advanced at a high enough stage to make the transition from male to female (or female to male) a complete one.
Biological sex has implications for health. One cannot simply wish away biological sex with cognitive dissonance because there are differences in health for biological men and biological women. Men have to be on the lookout for such things as prostate and testicular cancer as they get older. Women are more likely to have breast cancer than men. Colon cancer and Alzheimer's disease have an earlier onset for men than for women. I could list other examples, but I think the the point has been made. I would imagine that a lot of transgender individuals who are on HRT or who have had gender reassignment surgery are aware, but given how the discourse has been on this topic, I thought it merited emphasis.
Respect and human dignity. Regardless of the debate about the status of their biological sex, transpersons are still people, and thus should be afforded the same respect and human dignity as everyone else. We should be even more mindful of it when discussing these issues, especially considering that the transgender community faces higher levels of poverty, discrimination, suicidality, and violence.
Cancel Culture
This brings me to my final section for today: cancel culture. Cancel culture is a type of boycott, a boycott most associated with the Far Left, of an individual who either has an opinion that is questionable, unpopular, or distasteful, or alternatively has exhibited past behavior in the past (usually many years ago) that has now been deemed problematic. The behavior or opinions are to be viewed so heinous as to "cancel" the individual by boycotting them. In this case, it means boycotting Harry Potter because J.K. Rowling expressed views that some have deemed to be "transphobic."
I can see the appeal of cancel culture. Some think it is about re-thinking choices or bringing accountability to people for "woeful missteps" who previously could not be held accountable. Plus, cancel culture helps increase an individual's sociometric status (some research shows that sociometric status has become more important that socioeconomic status, e.g., Andersen et al., 2012), produces social cohesion, and provides immediate social rewards.
As a caveat, cancel culture proponents think that it is more about diminishing social capital and their influence in their world than it is a literal cancelation. If it were about literal cancellations, such celebrities as Dave Chapelle and Aziz Ansari wouldn't have a career anymore. For those celebrities who have a strong fan base and good PR people working for them, they will be fine.
As nice as that all might sound, cancel culture comes with major issues, as Leftist transgender YouTuber personality Natalie Wynn (uses the name ContraPoints) found out the hard way (see Wynn's video below). Wynn describes cancel culture as a milder digital version of mob justice reminiscent of the French Revolution.
Before detailing how she became a victim of cancel culture, Wynn explains quite well how cancel culture works. The first step is to have an assumption of guilt, which is contrary to the ideal in Western jurisprudence of presumption of innocence [until proven guilty]. The second step is to use abstraction, i.e., replacing a concrete detail with a more generic statement (e.g., Rowling made transphobic comments). After abstraction, one uses essentialism to go from criticizing a specific action to making a more general statement about one's personality and character. In the case of Rowling, it went from "she made a tweet supporting Maya Forstater after losing her job" to "she's a transphobic, trans-exclusive radical feminist [TERF]." As Wynn continues to explain, cancel culture comes with immediate escalation that rarely allows for time to reflect on one's behavior, has a lack of forgiveness, and is commonly used to create conflict instead of understanding.
Wynn's extensive criticism of cancel culture brings us to my own criticisms of cancel culture. Those jumping on the cancel culture bandwagon are guilty of the same absolutism and exclusiveness that they accuse Rowling and Forstater of exhibiting. I will use myself as as example. I can make an argument that transgender individuals should serve in the military, that a transgender bathroom ban is a solution in search of a problem, and that transgender people should be afforded human dignity, respect, and the life, liberty, and pursuit of happiness that should be afforded every American.
But for the cancel culture crowd, that's not enough. Their mob mentality echoes that oh-so-wonderful logical fallacy of President Bush: "You're either with us or against us." There is no room for the subtleties or nuances that life offers. If I managed to amass the clout of someone such as J.K. Rowling or Natalie Wynn, I could imagine the "cancel culture" crowd would come after me for not agreeing 100 percent and would probably call me transphobic.
J.K. Rowling is otherwise liberal: she supports gay rights, abortion rights, is eco-friendly, and donated £1 million to the Labour Party. But because she does not see eye-to-eye with LGBT activists when it comes to matters of gender and biological sex, she is labeled a hateful, transphobic TERF. If you don't agree with the cancel culture crowd, it's not simply about an intellectual disagreement. They cast the stones and deem someone such as J.K. Rowling to be evil.
It is not simply absolutist in what views are considered permissible, but it is absolutist in that it de facto demands perfection. If you made an insulting remark two, five, ten, or fifteen years ago, you should be cancelled, regardless of whether social or cultural norms were different back then. If we took the absolutist approach of the cancel culture crowd and applied the purity test to everyone, we would all be cancelled because we are all human. I am not saying that everyone's imperfections or incorrect actions are equal, but I am saying that we all say, think, and do stuff that is less than ideal. There are those who make truly incendiary remarks or have done something truly reprehensible, and we should call them out on it. Much like with political correctness, there is an inability to distinguish between what is mildly offensive and what is downright despicable and egregious.
And you know cancel culture is out of hand when the New York Times puts out a satirical video making fun of cancel culture (see below).
I believe that social media played a strong role in creating cancel culture because it created echo chambers. It has also incentivized media producers to spread fear and discord because they get more clicks than good news. Internet allows us great access to what we want to hear while we ignore everything else. So many people find it easier to reaffirm their preconceived notions than use critical thinking skills to come to an opinion based on facts and logic, and that has only been magnified with the Internet and such social media outlets as Facebook. Combine that with increased political polarization, and it's no surprise that cancel culture was conceived.
Postscript
We have lost the art of disagreement, and the backlash to J.K. Rowling's tweet is the latest example of how far we as a society have veered from civil discourse. President Barack Obama was right for criticizing cancel culture last year. Obama was right in saying that cancel culture does not bring about change, that it does not take into account the nuance or ambiguity that reality presents.
It's easy to show outrage and cast stones. What is truly difficult is interacting with those with whom you disagree and find common ground. I'm not saying this simply because an inability to separate the art from the artist will make enjoying culture seem like a miserable chore. Talking with those whom you disagree is a learning experience that broadens your horizons. Working with those with whom you do not agree is the essence of coalition building. You don't have to necessarily change your beliefs or values by doing so, but giving into the rancor and absolutism of cancel culture only seeks to divide and to set back civilization.
