The Republican Health Care Crackup

By 2010, however, both the Obama administration and the Tea Party opposition were out of step with the times. They both still thought the big political issues in American life were universal health care and the size of government.

.. In fact, another set of problems had magnified and come to overshadow the old set. This new set included:

First, the crisis of opportunity. People with fewer skills were seeing their wages stagnate, the labor markets evaporate. Second, the crisis of solidarity. The social fabric, especially for those without a college degree, was disintegrating — marriage rates plummeting, opiate abuse rates rising. Third, the crisis of authority. Distrust in major institutions crossed some sort of threshold. People had so lost trust in government, the media, the leadership class in general, that they were willing to abandon truth and decorum and embrace authoritarian thuggery to blow it all up.

.. If President Obama had made these crises the center of his administration, instead of the A.C.A., Democrats wouldn’t have lost Congress and the White House. If the Tea Party had understood the first two of these crises, there would have been no opening for Donald Trump.

.. he has no positive agenda for addressing them. He can tap into working class anxiety negatively, by harnessing hostility toward immigrants, foreigners and the poor. But he can’t come up with a positive agenda to make working class life more secure.

.. a group of Freedom Caucus Republicans who still think the major problems in the country today can be cured with tax and spending cuts. We have a Trump administration that has populist impulses but no actual populist safety net policies. And we’ve got a Republican leadership in Congress mired in Reagan-era thinking

.. The Republican plan will fuel cynicism. It’s being pushed through in an elitist, anti-democratic, middle of the night rush. It seems purposely designed to fail. The penalties for those who don’t purchase insurance are so low they seem sure to guarantee Republican-caused death spirals in the weaker markets.

.. But now you’ve got millions of people growing up in social and cultural chaos and not getting the skills they need to thrive in a technological society. This is not a problem you can solve with tax cuts.

.. voters around the world have demonstrated that they’re quite willing to destroy market mechanisms to get the security they crave. They will trash free trade, cut legal skilled immigration, attack modern finance and choose state-run corporatism over dynamic free market capitalism.

.. If you are pro-market, you have to be pro-state. You can come up with innovative ways to deliver state services, like affordable health care, but you can’t just leave people on their own.

Our Miserable 21st Century

From work to income to health to social mobility, the year 2000 marked the beginning of what has become a distressing era for the United States

the 2016 election was a sort of shock therapy for Americans living within what Charles Murray famously termed “the bubble” (the protective barrier of prosperity and self-selected associations that increasingly shield our best and brightest from contact with the rest of their society).

.. one recent New York Times business-section article cluelessly insisted before the inauguration, that “Mr. Trump will inherit an economy that is fundamentally solid.” But this is patent nonsense. By now it should be painfully obvious that the U.S. economy has been in the grip of deep dysfunction since the dawn of the new century.

.. We are witnessing an ominous and growing divergence between three trends that should ordinarily move in tandem: wealth, output, and employment.

Depending upon which of these three indicators you choose, America looks to be heading up, down, or more or less nowhere.

.. Between early 2000 and late 2016, the estimated net worth of American households and nonprofit institutions more than doubled, from $44 trillion to $90 trillion. (SEE FIGURE 1.)

.. for every unemployed American man between 25 and 55 years of age, there are another three who are neither working nor looking for work.

.. After World War II, work rates for prime women surged, and continued to rise—until the year 2000. Since then, they too have declined. Current work rates for prime-age women are back to where they were a generation ago, in the late 1980s.

.. In our era of no more than indifferent economic growth, 21st–century America has somehow managed to produce markedly more wealth for its wealthholders even as it provided markedly less work for its workers. And trends for paid hours of work look even worse than the work rates themselves.

.. On the nonmaterial front, it is likewise clear that many things in our society are going wrong and yet seem beyond our powers to correct.

.. Which “Cold War babies” among us would have predicted we’d live to see the day when life expectancy in East Germany was higher than in the United States, as is the case today?

.. Health has been deteriorating for a significant swath of white America in our new century, thanks in large part to drug and alcohol abuse. All this sounds a little too close for comfort to the story of modern Russia, with its devastating vodka- and drug-binging health setbacks.

.. journalist Sam Quinones notes in passing that “in one three-month period” just a few years ago, according to the Ohio Department of Health, “fully 11 percent of all Ohioans were prescribed opiates.

.. nearly half of all prime working-age male labor-force dropouts—an army now totaling roughly 7 million men—currently take pain medication on a daily basis.

.. In our mind’s eye we can now picture many millions of un-working men in the prime of life, out of work and not looking for jobs, sitting in front of screens—stoned.

.. But how did so many millions of un-working men, whose incomes are limited, manage en masse to afford a constant supply of pain medication? Oxycontin is not cheap.

.. For a three-dollar Medicaid co-pay, therefore, addicts got pills priced at thousands of dollars, with the difference paid for by U.S. and state taxpayers. A user could turn around and sell those pills, obtained for that three-dollar co-pay, for as much as ten thousand dollars on the street.

.. (21 percent) of all civilian men between 25 and 55 years of age were Medicaid beneficiaries. For prime-age people not in the labor force, the share was over half (53 percent).

.. for un-working Anglos (non-Hispanic white men not in the labor force) of prime working age, the share enrolled in Medicaid was 48 percent.

Of the entire un-working prime-age male Anglo population ..

.. (57 percent) were reportedly collecting disability benefits from one or more government disability program in 2013.

.. researchers estimates that the cohort of current and former felons in America very nearly reached 20 million by the year 2010.

.. The funny thing is, people inside the bubble are forever talking about “economic inequality,” that wonderful seminar construct, and forever virtue-signaling about how personally opposed they are to it. By contrast, “economic insecurity” is akin to a phrase from an unknown language.

.. The abstraction of “inequality” doesn’t matter a lot to ordinary Americans. The reality of economic insecurity does.

High on Hitler and Meth: Book Says Nazis Were Fueled by Drugs

Through interviews and documents that hadn’t been carefully studied before, he unearthed new details about how soldiers of the Wehrmacht were regularly supplied with methamphetamine of a quality that would give Walter White, of “Breaking Bad,” pangs of envy. Millions of doses, packaged as pills, were gobbled up in battles throughout the war, part of an officially sanctioned factory-to-front campaign against fatigue.

.. But the most vivid portrait of abuse and withdrawal in “Blitzed” is that of Hitler, who for years was regularly injected by his personal physician with powerful opiates, like Eukodal, a brand of oxycodone once praised by William S. Burroughs as “truly awful.” For a few undoubtedly euphoric months, Hitler was also getting swabs of high-grade cocaine, a sedation and stimulation combo that Mr. Ohler likens to a “classic speedball.”

.. “There are all these stories of party leaders coming to complain about their bombed-out cities,” Mr. Ohler said, “and Hitler just says: ‘We’re going to win. These losses make us stronger.’ And the leaders would say: ‘He knows something we don’t know. He probably has a miracle weapon.’ He didn’t have a miracle weapon. He had a miracle drug, to make everyone think he had a miracle weapon.”

.. Hopped-up soldiers would sprint tirelessly through the Ardennes at the onset of war, an adrenalized performance that left Winston Churchill “dumbfounded,” as he wrote in his memoirs. A German general would later gloat that his men had stayed awake for 17 straight days.

.. “I think that’s an exaggeration,” Mr. Ohler said, “but meth was crucial to that campaign.”

.. By 1944, the doctor had trouble finding veins to shoot. Then, as the Allies bombed the factories that produced Germany’s drugs, he had trouble finding opiates.

“Historians have tried to explain Hitler’s tremors that started in 1945 by saying that he suffered from Parkinson’s,” Mr. Ohler said. “I wouldn’t rule it out, but there’s no proof of it. I think Hitler was suffering from cold turkey.”

.. Mr. Ohler believes that Hitler’s drug consumption prolonged the war, by enabling his delusions.

The Extraordinary Intimacy Between the Ultra-Rich and Their Wealth Managers

For the one percent, a good advisor acts as a bookkeeper, a confidante, and, on occasion, a fishmonger.

.. While retaining legal counsel or consulting a financial adviser now commonly leads to short-term relationships, wealth managers maintain clients over the long term, sometimes amounting to lifetime employment.

.. It is not uncommon to find wealth managers working with the children or grandchildren of their original clients.

.. As one manager put it, the client has to “undress” in front of the wealth manager.

.. As a fiduciary, the wealth manager is bound to protect clients’ wealth from risk: This includes not just financial risk but the threat of spendthrift heirs dissipating the family assets or of family members with embarrassing secrets who might be targeted for blackmail.

.. one manager in Dubai described her client relationships in terms that emphasized the emotional labor and caring involved: “They’re asking you to take care of their family. You can’t just think of it as another piece of business … It’s not just a matter of signing documents; it’s the whole concept of doing the right thing for that family. You have to be able to say, ‘Mr. A., don’t worry—your kids are all going to be put through university. It’s all going to be okay.’ You have to be very businesslike. But also family-like.”

.. An English wealth manager based in Dubai explained that such outlandish requests are surprisingly common in the profession, in part as a way of testing whether the practitioner is “worthy” of the client making a long-term investment in the relationship:

.. And they don’t like change: they want to go to the same doctor all their lives, the same dentist, and the same lawyer or fiduciary.”

.. I said, “I’m your wealth manager, not your fishmonger.” And the client said, “Well, today you’re a fishmonger.”

.. Clients may also have a pragmatic reason for posing these tests: They allow the client to discover whether the wealth manager possesses the kind of social networks and influence necessary to provide extraordinary personal service.

.. a study of 19th-century British lawyers showed how their familiarity with clients’ business dealings allowed them to create whole new industries, such as the country’s railroad system; the professionals established a kind of private market, accessible only to the upper crust of British society.

.. Several specifically mentioned helping clients get treatment for their drug-addicted children—a particularly common problem in wealthy families.