If Elizabeth Warren really wants to unrig the system, she should focus on the Dream Hoarders

Odds are that you have not been following the recent libertarian dust-up over the merits of an Elizabeth Warren presidency. To give a brief recap: The main contenders were Will Wilkinson and Jerry Taylor of the “liberaltarian” Niskanen Center, who have been Warren-friendly to varying degrees; their opponents were colleague Samuel Hammond, along with Tyler Cowen of the more traditionally libertarian Mercatus Center, who touched off the whole debate with a withering critique of Warren’s policies.

A point-by-point exploration of their arguments would exceed the space allotted for this column by several thousand inches. But I think one can sum up the libertarian approach to Warren with a single question: How big a problem do you think billionaires, and the mega-successful corporations they helm, pose to the average American? Actually, come to think of it, I think that’s about how you’d sum up the question of Warren from any angle.

Which is why this debate ultimately matters to a lot more people than just some cranky libertarians: It speaks directly to a whole lot of young people who see that the economy doesn’t work for them the way it did for their parents and grandparents, and therefore conclude that somewhere along the way, the people it is working for — the barons of finance, the giants of Silicon Valley — must have rigged the system in their favor.

To be fair, they’re not entirely wrong. As Adam Smith once wrote, “People of the same trade seldom meet together, even for merriment and diversion, but the conversation ends in a conspiracy against the public, or in some contrivance to raise prices.” Bankers and tech executives very much included. So I find myself nodding in agreement with Wilkinson — and, by extension, with the progressive base of the Democratic Party — when he says: “Warren’s general diagnosis of the problem — it’s a rigged system of anticompetitive rent-seeking enabled by insufficiently democratic and representative political institutions — is broadly similar to my own.”

Yet they’re not entirely right, either. Are big corporations, or billionaires, or banks, or tech giants, or health insurers and pharmaceutical firms — to name some of Warren’s favorite targets — really the reason that young people are struggling

  • with enormous student loans? Are they the reason that millennial homeownership lags that of their parents? Are they the
  • reason that recent college graduates are more likely than their elders to be underemployed? Have they
  • driven the cost of health insurance to its current stratospheric levels?

Sure, Warren may be eager to sic her Consumer Financial Protection Bureau on your mortgage lender if you fall afoul of some obscure clause, but that’s not the problem for most Americans. They’re much more likely to struggle with finding affordable housing in prosperous cities. In fairness, Warren does have a plan to ease the zoning regulations that cause the shortage — but for some reason she rarely talks about it on the campaign trail, possibly because it’s constitutionally dubious, but more likely because it would alienate her affluent suburban base.

Similarly, Warren is eager to forgive student loans — a $1.6 trillion transfer to some of the most affluent members of society — but not to attack degree creep, which has walled off most of the best jobs for those who hold a bachelor of arts while enriching a lot of colleges. She targets insurers and drugmakers, but not the hospitals and medical workers who drive most of our health-care costs.

Too many of her proposals are like this; they focus on corporate villains or billionaires while ignoring the much broader class of people that Richard Reeves of the Brookings Institution dubbed the “Dream Hoardersthe well-educated upper-middle-class people who are desperate to pass their privilege onto their kids, and are unhappy about the steadily mounting cost of doing so. They’re Warren’s base.

Unfortunately, the Dream Hoarders — and I include myself in their number — are a much bigger problem for the rest of America than the billionaires whose wealth Warren promises to expropriate. Those billionaires got that way by building companies that disrupted cozy local monopolies, and they fund coding camps for high-school dropouts; Dream Hoarders

  • protect their professional licensing regimes and
  • insist on ever more extensive and expensive educations in the people they hire. Dream Hoarders also
  • pull every lever to keep their own housing prices high — and poorer kids out of their schools — while
  • using their wealth to carefully guide their children over the hurdles they’ve erected.

Which may be why the best predictor of a neighborhood with a low degree of income mobility is not the gap between the top 1 percent and everyone else — the gap that Warren focuses on with all her talk of taxing billionaires — but

If you really want to unrig the system, you need to focus less on a handful of billionaires than on the iron grip that the Dream Hoarders have on America’s most powerful institutions — including, to all appearances, Elizabeth Warren’s campaign.

Live interview: Marc Andreessen and Reid Hoffman, Co-Founder of LinkedIn | Code 2017

00:10
both for a long
00:13
many many debates with each of them is
00:16
really one of them named Marc Andreessen
00:19
for a long time now so let’s bring them
00:22
out Marc Andreessen and Reid Hoffman
00:24
[Applause]
00:31
you don’t
00:33
oh hello so I you know he was Marc
00:39
Andreessen has this habit of texting me
00:41
really rude things almost continually
00:42
and while I was sitting backstage within
00:45
10 feet of him he was tweeting at me
00:46
about that last talk so what did you I
think it’s very important because I
think Facebook is sucking the life out
of us
so what do you think that’s the
opening question outstanding uh so it’s
just sitting facebook director I think I
did I politely decline to answer
but oh
me let me jet let me generalize out so
this is something that one hears about
01:07
the internet a very son that’s the one
01:09
hears about the internet a lot so we
01:11
start by saying that that gentleman I’m
01:13
sure he’s doing fantastic work and he
01:14
clearly means well I really really
deeply disagree with everything
he just
said and the reason is because not just
because I had some role in creating the
whole thing but but a friend of mine Oh
Cronin who works in VR and is the
advanced thinker on these things has a
term he uses called reality privilege
and so it’s a view from the from the box
seats it’s the view from it’s a view
from places in the world that’s exactly
the kind of you get from places in the
world in which there are super rich real
world experiences to have right and so
you grow up an upper-middle class
community probably on the coast you have
these incredible schools you have these
incredible and rich activities you have
all these after-school activities
you’ve
always incredible people to talk to you
go to a college campus you get to you
know you get to hang out with all these
incredible super geniuses for the point
zero zero one percent of the population
of the world who gets to do all those
things then this internet thing is a big
step down for everybody else the
Internet is a giant step up right most
people
don’t have that level of reality
privilege like most people grow up in
places where there’s a much higher level
of what you might call intellectual
deprivation there’s just not that many
people around to talk to there’s just
not that many interesting things being
discussed there’s not that many great
experiences to have it’s hard to learn
new things the schools aren’t good I
mean all kind of you know most kids in
the world don’t even go to school like
or go to school up to the grade four
grade six to grade eight
it just can’t
progress beyond that point because
there’s there’s nothing locally there’s
there’s there’s just no local system
infrastructure or community to be able
to engage on ideas and so the internet
represents a giant level up on all those
topics for most the world and I think
it’s a fantastic thing
okay well then find snapchat for
everybody so read you like to oh well so
02:53
look I think that it’s it’s correct that
02:56
there is various forms of kind of call
it commercial system biases to come out
which is companies try to say look when
you want to occupy a bunch of time so we
try to figure out how to have that time
be occupied
and this is the similar true
this range is everything from the
agriculture industry which says will eat
more sugar like you have these
commercial biases the whole way through
and we adjust them now that being said
the overall system is better and we can
tune it right and so I think that the
one of the other things frequently is
not realizing there’s things you can do
to change for more of the that kind of
the good and they and and the bad and
these things and and obviously I am less
focused at the moment on questions
around the auto play
or kind of
equivalent and I’m more focused on
03:37
questions about like how do we get to
03:39
discernment of truth and how do we get
03:41
like you know truth media and what is
03:43
this whole fake news and all you know
03:45
facts and all that kind of stuff and
03:46
that is I think a much more deep issue
03:49
that I’m focused on at the moment well I
03:51
think one of the things that one of the
03:52
reasons I wanted to have these two was
03:53
one because you make investments you
03:55
change companies you decide you make a
03:58
lot of decisions that impact other
03:59
people too you’re you’re super
04:02
argumentative and debating about what
04:03
where that’s going you know where it
04:05
happened and I wanted people get a sense
04:07
from both of you of how where innovation
04:09
is going how it’s going because you’re
04:11
in none in charge of it but very
04:12
influential to the process both of you
04:15
in different ways so let’s start on that
04:17
idea that you just talked about which
04:20
brings in all of socially I’m not going
04:21
to pull out facebook but at all social
04:23
media the idea is something I’ve been
railing on recently for some reason is
that responsibility the social
responsibility the the civil
responsibility of social media companies
and other companies in Silicon Valley to
not to stop pretending these platforms
are benign
so as someone who’s created
these platforms each of you each of you
is on your part how do you look at them
now because I think they’ve morphed in
ways some people think social medias
become weaponized some people think
other things but that that take mark and
Marco Decker Brady’s been talking about
this a lot the idea of the
responsibility so how do you look at
where we are right now
for Silicon Valley why don’t we start
with you mark Ari how do you look okay
05:02
I’m happy to start okay look so I think
05:05
that the question is is that we had
05:09
presumed that broad brush that most
05:11
people could kind of make assert a ssin
05:14
of truth within their kind of normal set
05:17
and I think actually in fact it is
05:19
somewhat hackable it’s it’s filter
05:21
bubbles is one of the things that people
05:22
talk about a lot in the valley and kind
05:24
of how do you make sure that you’re not
05:25
blinded by it you have communications
05:27
that go across that there’s questions
05:29
about assertion of you know what is the
05:33
most relevant fact or in you know I
05:35
don’t think there is any such thing as
05:36
an alternative fact I mean I think
05:38
that’s that’s that’s that’s George
05:40
Orwell and and Aldous Huxley speak but
05:45
the but I think that the question is
05:47
okay how do we help people figure out
05:50
better guideposts to the truth because
05:54
simply being as part of the feed on the
05:56
screen sometimes is treated as too much
06:00
of that must be true and so what I think
06:02
is good is is I think the whole industry
06:05
and I’ve been part of a number of
06:07
conversations about ok what are the
06:08
right ways to do that and part of the
06:10
reason why they try to say it’s more
06:11
platform I don’t know if it’s trying to
06:13
say it’s benign is they’re trying to say
06:14
we’re not trying to impose a point of
06:15
view
we’re trying to help you get to
06:17
truth oh it’s kind of classic like what
06:20
is the algorithm part of it and and so I
06:23
think that there’s a lot of thinking now
06:25
about like what are the different ways
06:27
we can do that one of the things that I
06:29
think is is important is perhaps
06:31
building that out of the kinds of things
06:33
we trust like we trust other people and
06:35
can we get to some kind of version of ok
06:39
I know this kind of information is much
06:41
more contentious there’s a lot of people
06:43
who disagree with it this kind of
06:44
information is is something that I can
06:46
rely upon more and I think we need to
06:49
get to that kind of scoring system and I
06:51
think we need to make it simple enough
06:52
that it helps unify discourse across the
06:54
country how do you look at this so I
06:57
think truth has become shorthand for
06:59
things that people on the coasts believe
07:00
ok and fake news or false whatever
07:03
alternative facts has become shorthand
07:04
for people things that people in the
07:06
center of the country believe I think
07:07
this whole topic is gone completely off
of based on how in the wake of the
election so if you read the
coastal press which is generally
spectacular job I think I’m covering the
election last year but if you just read
the press in aggregate
where all the
stories the overwhelming thing that you
were carried away with was there is no
way on earth a Donald Trump can win this
election right it’s impossible you did
your the fantastic editor of the New
York Times up here on stage today they
had the day of the election they had
Hillary that morning at 92 92 percent
outs winning
election I saw the 92
percent out so it actually turned out if
you actually wanted to if you actually
wanted last year in 2016 to read the
story of the election actually get the
truth you read breitbart
now nobody
wants to hear that because we all like
have concluded that right Bart is like
absurd right-wing propaganda and that
somehow you know the tradition of the
coastal press is somehow the truth but
like it just like de bossed early last
year that was not true
so I just think
we all just need to take a step back on
this idea that there’s absolute truth
and that somehow we somehow have some
sort of monopoly or preferential access
07:58
to it and the rest of these people kind
07:59
of don’t understand anything
by the way it’s a surefire way to lose
elections because if Democrats are ever
going to lose elections are ever going
to win elections again in the center of
the country in the south of the country
they have to show up the some message
other than you’re all a bunch of morons

that’s not going to work that’s not
that’s not what the point is are these
you can split this and that is the
message yes I think that’s what’s being
heard yes but that’s an easy shorthand
way of saying no matter what they say on
the left though either coast is untrue
you can say untruth to people and get
them to vote a certain way
I mean
there’s it’s very you know you know if
you want if you want if you like your
health care plan you can keep it
right
right Obama 2008 right Obama care like
how’s that how’s that well I’m gonna
come in a close I’m gonna quote I’m
gonna close Guantanamo on my first year

in office you do it like for some reason
but the fact that politicians break
promises to us is not it’s not a very
big if you read the press coverage of
those promises at the time they were
presented as truth they were presented
as yes these are absolutely things that
are going to happen like there was there
were reams of coverage around Obama care
of how well it was going to work right
for news coverage over what is the
responsibility these platforms do they
have any because because Dean would say
no he said no they’re just there as
platforms he didn’t he thought the New
York Times that our responsibility they
necessarily don’t do you imagine all the
all these technology platforms have any
social responsibility mark has been
talking about it a lot he’s been
visiting lots of the country he’s been
petting livestock quite a bit

which is nice do you know how fluffy
cows are that they are apparently how’s
our super high I have been around many
cows I am aware of cows but how do you
how do you look at that responsible
because everyone seems to be visiting
doing that kind of thing they are in
Silicon Valley how do you look at their
is there a social responsibility for
this technology now we’re all going
where I grew up I know it’s amazing
thing I’ve ever seen oh and you left
there not going back so I’m gonna
frustrate I’m gonna I’m gonna frustrate
I’m just not gonna I can’t I’m sitting
back for Facebook
I need a wet face but
I talked about that Facebook but just in
general like as technology evolves do
you think that Silicon Valley needs to
have more of a social conscience so I
think it’s definitely a good idea for
businesses to have social conscience and
again this is where I would say I
believe there is much more but it’s
become very trendy to claim that Silicon
Valley doesn’t have a social conscience
10:07
and it’s just the default assumption is
10:09
that all these companies are doing
10:10
horrible things all the time and I just
10:11
don’t think it’s true okay all right I
10:13
don’t think the situation is anywhere
10:14
near as polarized as people are
10:15
presenting it well people liked it but
10:17
by the way Silicon Valley just if I
10:18
could from Silicon Valley people Cuba
10:21
lead a very much good and you will so
10:23
two years ago two years ago two years
10:26
ago the conventional wisdom right around
10:27
or much of the rest of the country and
10:28
that you read actually frankly a lot of
10:30
the press coverage in Silicon Valley was
10:31
it’s this hotbed of like these crazy
10:33
libertarians like it’s these crazy
10:34
extreme outlier like you know fringe
10:36
elements and of course our friend Peter
10:37
was kind of always kind of held up as a
10:40
good friend Peter a very good friend
10:42
Peter actually was held up as kind of
10:44
representative of the valley right a
10:46
funny thing happened last year which was
10:48
it turns out that was fake news okay it
10:51
turns out that was not true in fact it
10:52
turns out the opposite is true which is
10:53
the 99.999% of so look about last year
10:57
voted for Hillary Clinton supported
10:58
Hillary Clinton donated to Hillary
10:59
Clinton like it was over it was like the
11:01
money difference I don’t know is like
11:02
some giant multiple money difference
11:04
basic is nobody nobody nobody here Trump
11:05
and so the valley not whole is it as
11:08
well by the way may point out you
11:09
tweeted I’m with her correct that is if
11:11
it is true I well I will concede to that
11:12
okay I subsequently believe Obama
11:14
subsequently deleted all my tweets
11:16
including that look after that okay um
11:18
so what about it I think Silicon Valley
11:21
not only has has a real sense of social
11:23
responsibility if anything Silicon
11:24
Valley’s all the way over on the other
11:25
side
11:26
silk valley is extremely left-wing
11:28
extremely liberal and actually think
11:30
this is now this is become part of the
11:32
problem it’s now you have the other
11:33
version of the problem which is actually
11:34
I
11:35
it’s really hard for a lot of people in
11:36
Silicon Valley even articulate the other
11:38
side at this at this point it’s hard to
11:40
even articulate the case for voting for
11:41
Donald Trump I think it’s hard to
11:42
articulate what people in the Midwest in
11:44
the south are thinking and I think this
11:45
polarization thing it’s the general
11:47
problem that I was talking about earlier
11:48
but I think that I think the valley is
11:51
part of the Coast polarizing from the
11:52
center of the country to a much greater
11:54
extreme than we’ve ever seen in our
11:55
lifetimes all right now and it this does
11:57
not left unchecked this does not have to
11:59
good places okay this is great because
12:00
you didn’t want to talk about politics
12:01
at all but great okay so you have been
12:04
very active yes in that left-wing cabal
12:07
apparently and that’s the way we’ve all
12:10
it’s it’s like a way it’s like nearly
12:12
everybody know it’s a cabal so talk
12:15
about what you’re doing cuz I think
12:16
people are people are looking to you lot
12:19
everyone says we’ve got to get Reid as
12:20
the leader of this though yes but I do I
12:23
do I don’t ya know so talk about what
12:26
you’re doing precisely with Mark Pincus
12:27
and others yeah so mark who’s here in
12:30
the audience he and I started talking
12:32
years ago about how do you essentially
12:34
try to create consumer no technologies
12:36
to help shape a kind of pro-business and
12:40
also Pro kind of social values future
12:42
and how do you put that together into a
12:44
moment because I actually think part of
12:45
the whole thing is to get the bridge
12:47
building to make the right thing and I
12:48
think part of the social responsibility
12:50
for these growing strength of tech
12:53
platforms is to make that happen so I
12:55
think there is I think there is
12:56
responsibility I think it’s a growing
12:58
sense of it and I think people are
12:59
trying to figure out what it means and
13:00
how to operationalize it the right way
13:02
and then personally you know it’s
13:04
everything from obviously part of the
13:05
question that that that led to the
13:08
election of Donald Trump is there’s a
13:10
lot of people in a number of states that
13:11
are feeling in pain they worry that
13:13
their children have less good futures
13:15
and they had there is you know kind of
13:18
serious opioid epidemics and a number of
13:21
different states and and regions and
13:23
they say look these need to be fixed
13:25
don’t tell us more of the same tell us
13:27
how we have opportunity tell us how we
13:29
make that happen and I think you know
13:30
part of the thing about being invented
13:32
being problem solvers you know because
13:34
that’s part of what we try to do with
13:35
technology and businesses and so it is
13:37
we should do more of that now I think
13:39
another part of it is the earlier thing
13:40
is I do think we have a problem
13:42
I think the fake news thing is actually
13:44
levelled both ways like I don’t think
13:46
it’s a the coast saying the mid
13:48
Midwest I mean you’ve got your president
13:50
saying CNN is fake news etc etc I mean
13:52
you know you have the erosion of these
13:54
kinds of institutions and I we have to
13:56
be able to talk but if you can’t have
13:58
some basis for conversation which says
14:01
okay this is what we think truth is this
14:03
is where we think we should be going it
14:05
very difficult for democracy to work so
14:08
you know it’s everything from the kind
14:10
of win the future this is this
14:13
organization yes that WTF WTF with a
14:16
deliberate you know kind of on I see
14:18
what you’re doing yes yeah uh I find it
14:22
juvenile but go right ahead
14:23
Oh what we specialize in Juma I know
14:25
that no believe me after many years of
14:27
covering all of you like um and so I’m a
14:31
matter of fact actually one of my most
14:34
favorite theories of the evolution
14:36
humanities in the Otton II right we were
14:37
born early and and that plasticity and
14:40
ability to learn is is key so and so I
14:43
think there’s a whole stack of things
14:45
and I think some of it is like what is
14:46
the future work look like I think some
14:48
of it is the question of how do we get
14:50
communication channel how do we get to a
14:51
rebuild of here’s some kind of
14:54
communication like one of the projects
14:55
that I’ve funded at the MIT Media labs
14:57
called core Co which is done has done an
14:59
analysis through the Twitter firehose of
15:01
how fragmented the discourse is well how
15:05
do we get that discourse somewhat less
15:06
fragmented because with that with
15:09
fragmented discourse of course you end
15:10
up with you know kind of complete like
15:13
different planets no it’s a hellscape
15:15
out there but go ahead yeah so any with
15:17
that but that’s the well and then
15:18
there’s a whole question about how these
15:20
things get hacked by you know autocratic
15:23
hostile actors right and you know one of
15:26
the things that we have to pay attention
15:27
to is it is not necessarily purely just
15:30
the diversity of humanity that’s playing
15:32
on it but there are people who have
15:34
political aims that may be investing and
15:37
you know I’m really interested to see
15:38
what will emerge out of you know kind of
15:41
Russian and foreign power influence on
15:43
trying to hack social media because
15:45
that’s that’s kind of a key issue and I
15:47
think actually one of the things that
15:49
you know Brad Smith at Microsoft called
15:52
for that I think is real interesting is
15:54
how do we get to a Geneva Convention and
15:55
cyber I think that’s actually an
15:57
important thing to to look at happening
15:59
because part of that is what
16:02
happen with these things being hackable
16:03
a little bit like they talk just before
16:05
us your attention can be hacked in ways
16:08
that it isn’t just code hacking this is
16:11
just cyber but it’s kind of a question
16:12
of what you presume to be true and and
16:15
you know we want a vibrant democracy we
16:17
have to try to to get to a point so
16:20
we’re having rational conversations and
16:22
we’re actually using evidence and
16:24
argumentation to decide X is true and Y
16:26
is not right all right I want to get to
16:28
where innovations going think that’s
16:29
really what investments is but are you
16:31
you investing a lot of your money in
16:33
this I’m not supposed to call you a
16:34
certain thing of the left but what are
16:36
you investing a lot of money do you want
16:38
to run for office
16:39
definitely not run for office why well
16:42
look I I prefer the partnering board
16:47
member investing that’s one of the
16:49
reasons that guy behind it yes yeah I’m
16:51
guy behind you of LinkedIn the
16:53
smoking-room yes yeah yeah role model
16:56
for elbows who didn’t get the X Files
16:59
right yeah and so and then but I’m
17:05
vesting a bunch of money I’m trying to
17:06
actually facilitate conversations trying
17:08
to facilitate what the right kinds of
17:10
ideas are like what are the ways that we
17:13
can make sure that we have you know
17:15
vibrant economic ecosystems and
17:17
middle-class jobs across the country
17:18
which my network ultimately a lot I’d
17:22
say thus far is probably millions
17:24
millions but hundreds of millions you
17:26
think this is it could get there could
17:27
get there all right so let’s talk about
17:29
where and Mark you’re not running for
17:32
office I hope okay I would not advise
17:35
thank you can you imagine anybody voting
17:36
for me yes I don’t I might just as a
17:40
joke separate you got to oh if I run
17:43
I’ll take the sarcastic alright so let’s
17:46
talk about innovation where it’s going
17:48
you guys have been around forever
17:49
there’s been a lot of different
17:50
investments and periods of time and
17:53
things like that and it is related to
17:55
jobs the future of jobs let’s start with
17:57
there how do you look cause I think to
18:00
me it seems like Silicon Valley is doing
18:01
a lot more serious thought about
18:02
investing beyond into the into it into
18:05
the next era cars automation robotics
18:08
each of you want you start Marc talk
18:10
about you think of the most last time
18:12
you were here you’re talking about
18:13
software eating the world
18:14
talked about a wide range of things how
18:16
are you thinking now about investments
18:18
yes it’s interesting we have two sectors
18:21
two different kinds of economy in the US
18:24
or do two different kind of categories
18:25
of sectors divide them in one might call
18:27
the fast sectors and the slow sectors or
18:29
the fast chain sectors slow chain sector
18:30
so the fast chain sectors are sectors
18:32
like retail transportation media in
18:35
which technology has had a huge impact
18:37
software is eating those sectors there’s
18:40
massive change happening in those
18:41
sectors massive productivity
18:42
improvements as measured by productivity
18:44
which is how economists measure the rate
18:46
of technological change by the way Janak
18:48
churn in in jobs right turn in obviously
18:52
media and retail and you’re in BuzzFeed
18:54
you’re in a bunch of yeah yeah exactly
18:56
right and in lots of debates about the
18:57
nature of that churn by the way however
18:59
along with that rapidly falling prices
19:01
right so the prices of basically
19:03
everything and reaching or as if the
19:05
experience everybody has an Amazon
19:06
customer prices in retail prices in
19:08
media with all the free media and
19:09
internet and prices in transportation
19:11
are going to fall you know dramatically
19:12
with self-driving cars and so very
19:15
rapidly falling prices but like a big
19:17
and then a big concern of where the jobs
19:19
going to come from so that’s part of the
19:21
economy the other part of economy is
19:22
what you might call the slow change part
19:24
of the economy which is all the sectors
19:25
in which the opposite of that is
19:27
happening and so these are sectors like
19:29
health care education and construction
19:32
elder care child care and also by the
19:35
way government so took all those kind of
19:37
the big six in those sectors the
19:39
opposite is happening which is in those
19:40
sectors we have a price crisis right the
19:42
price of all those things is rising
super fast right so that the FT had a
story today eighty eight percent of all
the price inflation in the US economy
since 1990 is attributable entirely
eighty eight percent of it attributable
to health care education and
construction
right and so what’s
happening on and the sort of the slow
change sector of the economy is
19:59
basically everything’s becoming super
20:00
expensive and if you try to buy a house
20:02
or if you want to send a kid to school
20:04
or if you need to get care for an ailing
20:06
relative you experience this and hence
20:08
all the concern around the cost of all
20:10
these things those are the sectors the
20:12
economy the technologies having almost
20:13
no impact on right software is playing a
20:15
very small role at best those are also
20:18
the sectors that have almost no
20:20
productivity growth right as measured by
20:21
economists and left unchecked those
20:23
sectors are basically just going to eat
20:25
the economy right if those if the if the
20:28
products and services in those sectors
20:29
keep rising in price they end up being
everything we pay for health care is
eating the account yeah health care
healthcare education and construction of
the big three and there’s eating the
economy fully-loaded construction costs
have doubled since the year 2000 in the
US I mean just like absurd things are
20:42
happening in real estate and
20:42
construction and so I think the
20:45
opportunity and the challenge is for the
20:48
tech industry in Silicon Valley and all
20:49
of us to go figure out how to have a
20:51
much bigger impact in the in the slow
20:53
growth sectors of the economy the slow
20:55
change sectors the economy I think if we
20:56
do that if we’re effective at it we have
20:59
the opportunity to bend the cost curves
21:00
over time and these by the way are very
21:02
very big sectors with very very big kind
21:04
of entrenched forces I play by the way
21:06
these also the slow change sectors also
21:08
happen to be highly regulated right
21:09
these are sectors of the economy where
21:10
the government plays a gigantic role in
21:12
the economics of these sectors and so
21:13
these are not easy sectors to disrupt
21:15
these are this is the big leagues but
21:18
the opportunity exists to really go
21:19
after the price curves and
21:20
systematically drive down prices in
21:22
those industries if we do that like that
21:25
may be the single biggest thing we could
21:26
do to improve quality of life for a
21:28
living that’s ordinary people we are
21:29
actively investing so super actively
21:32
investing education Udacity one of our
21:34
companies going directly after skills
21:35
acquisition doing very well with an
21:37
entirely new way to link with employers
21:39
to do skills acquisition training online
21:40
we’re very aggressively investing in
21:42
healthcare we think there’s a whole new
21:44
very interesting thing happening at the
21:45
intersection of healthcare and software
21:47
that’s just getting started and we’re
21:49
investing very aggressively on that
constructions harder you know the big
challenge that we’re all going to have
to tack on the long run is this sort of
question of cities and this question of
land use
and whether cities are going to
be allowed to get big enough where
everybody who wants to get to them is
going to be able to get to them Mayer
Swisher in San Francisco I think it’s
22:05
going to have this on the top of her
22:06
list yeah as thanks to solve oh really
22:09
so that’s the sector that’s a second be
22:10
you’re going to be my deputy of
22:12
something I’m looking forward to it yes
22:14
yes I will take that on my business card
22:16
so that’s a big one we’re also by the
22:18
way elder care and childcare are both
22:21
both are increasingly central elements
22:25
to the economy huge employers in both
22:27
fast rising sectors we have a company
22:29
honor that I’m involved in that’s trying
22:30
to come up the fundamentally better way
22:31
to orchestrate whole process go right
22:33
here mean what about you know so
22:36
slightly different division so I think
22:39
about things that are kind of classic
22:41
for what we do
22:41
is kind of businesses with network
22:43
effects which can include both consumer
22:45
and enterprise sides so those are things
22:47
like you know obviously Airbnb or convoy
22:50
which is kind of over for trucking
22:52
we just recently can we still use that
22:54
uber for or is that not allowed uh well
22:57
I think we always use the version of it
22:59
I mean before whatever it’s a it’s a
23:01
it’s a quick did that for mark or prefer
23:03
X is better now because it has an extra
23:05
element of danger okay ah the lyft guy
23:10
that one guys
23:12
and so there’s a stack of those sort of
23:15
businesses which I think are the I think
23:17
we will continually design new forms of
23:20
software ecosystems that have these
23:22
network effects that organize how
23:25
millions to billions of people
23:26
communicate work you know kind of
23:29
coordinate communicate all that sort of
23:32
thing together and then part of what we
23:35
look for is what are things that are
23:37
substantially contrarian that are not in
23:40
the kind of the current you know cut a
23:41
buzz cycle right the buzz cycle okay is
23:44
AI ARV are you know etc and then what
23:50
are the things that they’re you can
23:51
actually do something that actually
23:53
might be really interesting some of
23:55
those will play out into those
23:56
industries so you know if you figure out
23:59
different kinds of of construction you
24:03
know robotics so you figure out you know
24:05
energy sources or other kinds of things
24:06
those can actually play into those and
24:08
can actually change those cloths curves
24:09
so it isn’t it is it’s a different way
24:11
of looking at it which is kind of
24:13
through the lens of these things or
24:14
defining kind of network effects
24:16
software ecosystems with people and and
24:20
devices you know kind of combined
24:22
together and then these things are
24:23
what’s kind of off the current beaten
24:26
path so what is that what do you name
24:28
something so let’s see what can i name
24:34
well i mean so you know one of the
24:37
things that we did last year is a energy
24:41
company which i can’t talk about in
24:42
depth all right what kind of energy uh
24:45
so possibly fusion possibly fusion look
24:51
Oh God yeah and and investing in that in
24:56
a new and exciting way yeah okay all
24:59
right
25:00
what about robotics so I think robotics
25:03
is generally speaking one of the areas
25:05
that everyone knows is going to be super
25:07
important everything from autonomous
25:08
vehicles to other kinds of things
25:09
so there’s AI just a ton of them like
25:12
the number of autonomous vehicles
25:14
startups is yeah they’re like yes is
25:16
like an uncountable set but it’s clearly
25:20
going to be there and then robotics are
25:21
going to be like for example when you
25:22
started saying construction I was like
25:24
oh robotics is the interesting you know
25:26
angle is the first reflex there and I
25:29
think there’s going to be a bunch of
25:30
things there which some of which we’ll
25:32
see from the big companies I think some
25:33
of it you’ll see from startups what do
25:35
you that robotic because you know Bill
25:36
Gates was just saying we should tax
25:38
robots that right and then mark injuries
25:40
is Mark Cuban is saying we’ve got to get
25:43
into it because China is going to do
25:45
this first we should is horrible and
25:46
evil but we have to we have to we have
25:48
to be really good at it yeah this is a
25:50
little bit of a paradox in there so we
25:53
should definitely tax robots right after
25:54
we get done taxing pcs okay uh which
25:56
took away all the secretary jobs all
25:58
right okay so I’d do it in that order
26:00
okay all right so so far how do you look
26:02
for Microsoft hasn’t taken us up on that
26:04
all right how do you get to what do you
26:05
imagine robotics is going oh it’s very
26:07
the content we’ll get to the job issue
26:09
in a second but you know but talk about
26:11
the sector’s automation and robotics
26:13
together and I suppose AI also gets in
26:17
that pot yeah so look so the big thing
26:18
is the big thing is happening is that
26:20
the so-called so-called AI but machine
26:23
learning the whole the whole sort of
26:24
family of technologies around Aero
26:25
machine learning and sensors right
26:26
something dramatic has really happened
26:29
something dramatic really tipped about
26:30
five years ago we’re a whole category of
26:32
things that just didn’t work at one
26:33
point all of a sudden work and so I just
26:35
I think – I think at this point there’s
26:37
just a feeding frenzy in the tech
26:39
industry in the valley to try to
26:40
experiment with every single possible
26:41
permutation what can be done with AI and
26:43
robots at every possible shape size and
26:46
description it’s I think it’s
26:48
spectacular it’s a it’s it’s one of the
26:50
biggest it’s one of the biggest booms
26:51
slash kind of exploratory let’s go map
26:54
the landscape and let’s go try all the
26:55
ideas that I think I’ve ever seen and
26:56
what do you know and we’re actively
26:57
investing what do you like about that
26:59
what do you end what are you worrying
27:00
area when you say if everyone’s pursuing
27:02
it just oh it’s a classic it’s the
27:04
Silicon Valley it’s the thing that it’s
27:05
the thing that gets everybody excited
27:06
about Silicon Valley and then it’s the
27:07
thing everybody always criticizing
27:08
Silicon Valley for which is of course
27:10
we’re going to overdo it like of course
27:11
there are way too many companies being
27:13
funded doing self-driving cars but out
27:14
of so what always happens in the valley
27:16
right the great strengths of the valley
27:18
I would argue is that when something
27:20
starts to work we over fund it like we
27:21
have way too many companies going after
27:23
this most of them don’t work but the
27:25
ones that do end up becoming very big
27:27
and important right and ultimately
27:29
valuable and so well I think we’ll get
27:30
that exact exact same result out of this
27:32
phenomenon for people who want to say
27:34
the Silicon Valley just does well pulls
27:35
over and over again there will be
27:36
ammunition to support that view but I
27:38
think out of that will come you know
27:39
defining companies of the era that we
27:41
probably haven’t even heard of the app
27:42
that are going to be on the on the scale
27:43
of the big technology win in that sector
27:45
in that sector yeah the opportunities
27:46
are very very very big do you worry
27:48
either view about the job impact when
27:51
we’re talking and I want to understand
27:52
where you look at the where you feel the
27:54
responsibility if you have any on the
27:56
future of jobs it’s the thing I’m very
27:58
interested in well so and obviously I
28:00
mean to some degree what I found in
28:03
LinkedIn was trying to help people
28:04
figure out what the skills jobs
28:06
opportunities of the future so taking
28:08
software and networks to enable that and
28:10
enable people to be able to find the
28:13
right opportunities get the right skills
28:15
get the right connections to those kinds
28:17
of things that’s actually very central
28:18
let me give you a kind of a classic kind
28:21
of thought on within the autonomous
28:23
vehicles because people frequently say
28:24
oh these home Thomas vehicle is going to
28:26
take a whole bunch of jobs there’s an
28:28
issue there and you have to get that
28:29
transition but on the other hand once
28:30
you have autonomous vehicles for example
28:32
being able to have people now actually
28:35
in fact go be able to get to work in a
28:39
much more easy way to be able to
28:40
actually when they’re in transit to be
28:43
actually doing things that are either
28:44
relaxing or working as a way of doing it
28:46
it also opens up a variety of
28:49
productivity possibilities no I get that
28:51
argument of like you can now text and
28:52
drink I get that I get you know it’s
28:54
it’s all that I drink is the funnest
28:55
thing the texting all right the but it
28:58
is that happy shiny future idea of like
29:00
oh it’s going to be so much the same
29:01
thing with AI same thing with that mark
29:04
you were just going to say something but
29:04
what I wonder about is when that happens
29:07
there are millions of jobs driving take
29:11
driving millions of jobs and I think
29:13
when Travis was on this stage
29:14
said the problem is the guy he actually
29:16
was honest compared to most people sit
29:20
by saying the guy in the front seats the
29:21
problem we need to get rid of the guy in
29:23
the front seat you know I mean which
29:24
everyone we had a sharp intake of breath
29:26
I was like yay he said it but but what
29:30
do you how do you look at that do you
29:32
feel what are you going to do about that
29:34
or do you have nothing to do about it
29:35
so it’s a fallacy okay it’s the lump of
29:38
Labor fallacy is the Luddite fallacy
29:39
it’s it’s recurring panic this happens
29:41
every 25 50 years people get all amped
29:43
up okay machines are going to take all
29:44
the jobs and it never happens so let’s
29:45
talk about cars specifically because
29:47
that that’s front center for the
29:48
conversation so when the automobile 100
29:50
years ago in the automobile went
29:51
mainstream this concern literally
29:52
existed exactly same panic happened it
29:55
happened because of all the people whose
29:56
livelihood literally was taking care of
29:57
horses right so everybody running
29:58
stables and everybody doing blacksmiths
30:00
and like the whole thing an I god what’s
30:02
going to happen cuz Ford Motor Company’s
30:03
you know in the world and nobody else is
30:04
going to have anything to do the car
30:06
then created not only a lot of jobs
30:08
building cars right it became a huge
30:10
employer right now the car industry
30:12
became such a huge employer that we had
30:13
to bail out all the car companies to
30:14
keep working like a hundred years it
30:16
went entirely in the other direction not
30:19
only that the car think of everything
30:21
else that happened as a consequence of
30:22
the car so the idea of surface streets
30:24
right paved streets emerge because of
30:26
the car right streets weren’t paved
30:27
before the car they were paid for the
30:29
car so paving streets the idea of the
30:31
idea of restaurants the idea that you
30:33
might actually go someplace to eat
30:34
something was an invention of the car
30:36
the idea of motels hotels the place
30:39
we’re in here is it exists entirely
30:41
because the automobile the idea of movie
30:43
theater is the idea of apartment
30:45
complexes the idea of office complexes
30:47
the idea of at some suburbs the entire
30:50
build-out of suburban America the jobs
30:53
that were created by the automobile on
30:54
the second third and fourth order
30:55
defects were a hundred X a thousand X
30:58
the number of jobs the blacksmith’s had
30:59
and so this goes to kind of the
31:01
fundamental kind of flaw in the logic
31:03
that they call the length of labor
31:04
fallacy which is technological change
31:06
causes productivity growth productivity
31:08
growth lets us produce more of what we
31:11
can already make with less resources and
31:13
then lets us create that that’s what
31:15
frees up the spending power to let us
31:16
create lots of new things great lots new
31:18
demand and that’s what creates new
31:19
industries and that’s what creates new
31:20
jobs and then 100 years later we look
31:22
back on it we’re like I can’t believe
31:23
anybody who’s ever a blacksmith and so
31:25
this has been the pant literally this is
31:27
like the panic every
31:28
8550 years except if you are a
31:29
blacksmith and it never comes true the
31:32
good news is you didn’t work out the
31:33
good the good news is the car company
31:35
the car companies and all of these other
31:37
industries hired huge numbers of people
31:38
and so I think the self-driving car has
31:39
the opportunity to not only improve
31:42
productivity for people in the car which
31:44
will be a huge economic boost for those
31:45
people not only has the opportunity to
31:47
save lives right over a million people
31:49
died worldwide in road deaths today
31:50
caused by human drivers and I think we
31:52
can take that very close to zero right
31:54
which is very good for both human
31:55
welfare and in terms of economic
31:56
productivity right it’s it’s like it’s a
31:58
very serious dent in productivity when
32:00
people get killed and then and then and
32:04
then and then and then all the all the
32:07
ancillary industries that end up getting
32:08
built out so as an example maybe this
32:10
whole land use thing everybody’s worried
32:11
about maybe with salt driving cars we
32:13
can start to have excerpts that actually
32:15
work which is to say another layer
32:17
around cities right further out right
32:19
they don’t qualify as suburbs because
32:21
you couldn’t tolerate couldn’t possibly
32:22
tolerate commuting in an hour hour and a
32:24
half right so people in Silicon Valley
32:25
right experiencing if you live south of
32:27
San Jose your commute now might be an
32:28
hour and a half but it’s not half in the
32:29
car driving the car if you were in the
32:32
self-driving car all of a sudden then
32:33
you’ve got you might have a huge
32:34
construction boom in all the outlying
32:35
areas around these cities and that
32:36
construction boom might hire for more
32:38
people than were ever involved in
32:39
driving cars so well and so the process
32:41
works by the way as evidence of that
32:44
after all of the technological
32:46
disruption that has everybody all
32:47
freaked out that got us to where we are
32:48
today
32:48
right unemployment in the u.s. is now
32:50
back below it’s not below 4.3 percent
32:52
right there’s if you’re living in areas
32:54
like Kentucky there’s six million
32:57
there’s six million job openings up in
32:58
the US and the the panic stories in the
33:01
press have gone overnight from oh my god
33:03
not enough jobs to oh my god not enough
33:05
workers right and The Times is an
33:07
example of Dean’s paper had a very good
33:09
story about two weeks ago on there’s an
33:10
hour crisis in Utah there aren’t enough
33:11
people to literally milk all the cows
33:13
they’ve literally run out of people to
33:15
milk the cows and so what the the jobs
33:16
crisis we actually have in the u.s.
33:18
today is we don’t have enough workers
33:18
it’s aimed in the right thing by the way
33:21
we might make that you know for this if
33:22
these immigration policies continuing we
33:24
might make that problem far worse yeah
33:25
okay you’re in for immigration very much
33:28
okay good
33:29
what are you worried about are you
33:32
worried about this at all then we’re
33:33
going to get to questions well so the
33:35
one thing I agree with most of what Mark
33:37
said there including the fact that if
33:39
you remap what is the logistics and
33:41
space
33:42
it creates a lot of different
33:42
productivity not just construction but a
33:44
lot of different ways that that may play
33:46
out and change his clusters
33:48
I think the transitions can be very
33:50
painful so I think we need to pay
33:52
attention to the pain that pain so like
33:53
example the agriculture – Industrial
33:56
Revolution actually involved a large
33:58
ugly very ugly and so while I tend to
34:00
think oh look it works out it’ll
34:02
probably work out anyway the the
34:04
question is let’s try to make it work
34:06
out in a way that’s more humane more you
34:10
know kind of the society that we want to
34:11
be and kind of not as much pain in that
34:13
kind of transition right absolutely do
34:15
you think about that pain so look so
34:17
whatever you just Blofeld or what’s
34:19
don’t let me ask so let’s talk about
34:22
what’s actually happening so these are
34:23
all hypotheticals are both actually
34:24
happening so economists have a way of
34:26
measuring the rate of technological
34:27
change disruption in the economy is
34:29
called productivity productivity growth
34:30
would we expect based on everything that
34:33
we read here and understand with this
34:34
rate of technological change and
34:35
disruption would we think that
34:37
productivity growth is at generational
34:38
highs or lows I’ll be highs right and it
34:41
turns out it’s a it’s a generational
34:43
lowest productivity growth is running
34:44
super low and economists are writing
34:46
books left right and center agonizing
34:47
over why productivity isn’t growing
34:48
faster would you expect that the rate of
34:50
job churn the rate of both job creation
34:53
and destruction in the economy which
34:55
tend to go hand-in-hand would you expect
34:56
that those the rate of churn is at a
34:58
generational higher generational low no
35:00
idea I’m not going to answer so it’s a
35:01
trick it’s a trick question as you
35:02
anticipated oh just right now
35:04
everything’s a trick question with you
35:06
the rate of job churn American economy
35:08
has been declining for 40 years and it
35:09
shows no sign of growing would you
35:11
expect that the rate of which people are
35:12
turning over in jobs individuals turning
35:14
over in jobs is increasing or decreasing
35:16
well Millennials are who everybody but
35:18
just everybody is the set by the way
35:19
including Millennials probably are
35:21
decreasing all right people are staying
35:22
in jobs longer and would you expect
35:24
because of all the disruption that we
35:25
know about would you expect that the
35:26
rate of new entrants of new companies
35:28
and existing industries is accelerating
35:30
sorry it’s decelerating okay we don’t
35:33
have the problem work at 11:00 p.m. we
35:35
don’t have I haven’t even had a Scott
35:37
yet okay that can be fixed that can be
35:41
fixed we don’t even we don’t we do not
35:43
not only do we not have the problem
35:44
everybody’s worried about we have the
35:45
opposite problem we don’t have enough
35:46
change we don’t have enough change we
35:48
don’t have enough creation of new jobs
35:50
we don’t have enough creation a new
35:51
opportunity which is what in my view
35:52
goes right back to the politics is what
35:54
leads to zero-sum politics
35:55
the reason our politics is going
35:56
sideways is not because there’s too much
35:58
changes because there’s not enough
35:59
change because people don’t see a future
36:01
because they don’t see anything changing
36:01
and I think you see the zero the zero
36:03
sum politics you see that sense on both
36:05
the left-right with you on the Bernie
36:07
left and on the Trump right I think
36:09
that’s the problem the way through that
36:10
is not just slowed down the way through
36:12
that is to speed up right the way
36:13
through that is more change more growth
36:15
more opportunity all right that’s the
36:17
path forward and so I does this goes
36:18
back to like I’m just I’m very worried
36:20
that we’ve actually gotten off and we’re
36:21
just talking about completely the wrong
36:22
thing right now and I’m hoping maybe
36:24
over the next couple yes yes we can
36:25
massage this a little bit more towards
36:27
the actual the actual crisis that we
36:28
have all right questions from the
36:30
audience right here hey guy Horowitz T
36:33
capital are you so this is a very
36:36
Silicon Valley centric view which is
36:40
where you guys are is the world changing
36:43
in that respect are we seeing more ideas
36:46
and concepts coming from other parts of
36:49
the world so I think the I think the
36:53
answer to the question in some degree is
36:55
both which is yes there’s more
36:57
entrepreneurship there’s more technology
36:58
there’s multiple areas not just
37:00
obviously a huge amount of stuff going
37:02
on in China but like when you get to
37:04
Europe it’s you know Stockholm and
37:06
Berlin and London there’s various cities
37:08
across the u.s. on the other hand
37:10
frequently that’s the is the Silicon
37:14
Valley losing some of that’s always the
37:16
class and I actually think that Silicon
37:17
Valley is persisting because of the
37:19
network effect of Silicon Valley in
37:21
terms of lots of entrepreneurs move here
37:24
the ideation moves at a very fast pace
37:26
rate because people talk to each other
37:29
about what’s what’s going on what truth
37:31
what are you seeing in autonomous
37:32
vehicles which things going to work etc
37:33
etc and that also creates something so I
37:35
think the answer is some grades yes to
37:38
the rest of the world but also
37:39
continuing very interesting patterns of
37:42
leadership from Silicon Valley are you
37:44
worried about Slocombe I was losing its
37:45
step no never never
37:47
not right now yeah well we’re doing
37:49
everything we can to kill it but as a
37:50
part we so far we keep so far we keep
37:52
missing all right we collectively the
37:55
state of California oh okay consider San
37:56
Francisco alright got it okay good I’m
37:58
gonna make it even worse for anyway
38:02
hello Manny Cuchillo

What Kind of Health Care System Should the U.S. Adopt? Part II

The Institute for Freedom & Community at St. Olaf College seeks to promote free inquiry and meaningful debate of important political and social issues. By exploring diverse ideas about politics, markets, and society, The Institute aims to challenge presuppositions, question easy answers, and foster constructive dialogue among those with differing values and contending points of view. Established in 2015, The Institute offers a distinctive opportunity to cultivate civil discourse within a liberal arts setting. See more at institute.stolaf.edu

This is the final event of the IFC’s spring 2018 series: “Freedom, Community, and Health Care,” featuring a conversation between Amitabh Chandra and Tyler Cowen, moderated by St. Olaf College Associate Professor of Economics Ashley Hodgson.

Amitabh Chandra is the Malcolm Wiener Professor of Public Policy and Director of Health Policy Research at the Harvard Kennedy School of Government. He is a member of the Congressional Budget Office’s Panel of Health Advisors, and is a research associate at the National Bureau of Economic Research.

Tyler Cowen is an economist, blogger, best-selling author, and professor of economics at George Mason University and at the Center for the Study of Public Choice. He is also the director of the Mercatus Center, a research center dedicated to bridging the gap between academic research and public policy problems by training students, conducting research of consequence, and persuasively communicating economic ideas to solve society’s most pressing problems and advance knowledge about how markets work to improve people’s lives.

How Corporations Destroyed American Democracy – Chris Hedges.

How Corporations Destroyed American Democracy – Chris Hedges.
Filmed at Socialism 2010 in Chicago by Paul Hubbard

Healthcare Choice: I want to give them less and make them think it’s more

00:00
earlier in this hour we heard the
00:03
results of a detailed survey done with
00:06
working-class voters in Ohio
00:09
obviously a swing state obviously an
00:11
important state on the issues that
00:14
mattered to them and what we heard was
00:16
that about a third of them can’t be
00:18
moved because they’re just rock hard
00:19
right winter is racist whatever and we
00:24
heard that there are at least a third of
00:26
them who definitely can be moved
00:28
including some former Trump voters as
00:30
well as a working-class voters of other
00:33
kinds and we learned that these movable
00:35
voters are not only unafraid of big
00:39
ideas they love big ideas now they’re
00:42
not deep into the policy details but
00:44
they love the idea of a green new deal
00:45
they love the idea of Medicare for all
00:48
and so on so the question is how do we
00:51
reach these reachable voters and why
00:55
would be.we be afraid of the ideas they
00:58
embrace but we have an entire
01:01
politically political industry that
01:04
includes the Republican Party and large
01:06
chunks of the Democratic designed to
01:08
make them afraid of big ideas and that
01:11
is what we need to fight I’m gonna
01:13
suggest here’s one way to fight it by
01:17
telling them simple plain truths about
01:21
policies like Medicare for all and like
01:24
the green new deal and I want to talk a
01:25
little bit about Medicare for all for a
01:29
very specific reason I used to work and
01:31
some of you may know in the health
01:34
insurance field and related fields
01:38
and I used survives large corporations
01:40
worked for large corporations I’m not
01:43
proud of it but I guess the information
01:45
it’s useful now I’m not ashamed of it
01:47
either it’s just in what I what I was
01:49
aware of at the time and then an
anecdote came to mind recently which I
talked about at a Tedder of speech I
gave the other day and I want to share
it with you now because I was asked to
come in and advise in the 1990s one of
the most powerful CEOs in the country
ran an entire insurance Empire himself
and he
called in his advisors of which I was
considered one and he had all these
ideas for the employee health plan and
benefit plan cafeteria plans and flex
plans these were all buzzwords that were
around then and choices and options and
lists and and the group of people around
him many of whom were human resource
professionals didn’t even know what he
was driving at with all of this except
that he was using the terms so as the
then young and sort of brash person in
the room I said excuse me what exactly
are you trying to accomplish with the
employees here with all of this and he
said I want to give them less and make
them think it’s more
now that phrase is
always stuck with me and I wanted to
stick with you if you’re willing I want
to give them less and make them think
it’s more choice is a game that is often
used to give us less and make us think
it’s more
what should we have when it
comes to medical care we should have the
treatment we need when we need it by the
doctor we want at the facility that’s
best for us with the medication we need
we don’t need quote unquote choice of
insurance companies to see if they can
provide us any of those things and we
can’t use that information because we
most of the time don’t have any idea
what our upcoming health needs are gonna
be it’s a game they want to give you
less and make you think it’s more so if
nothing else fine part nothing else to
you from all of this
I want please when you hear a candidate
say as people to judge says I don’t
support Medicare for all I support
Medicare for all who want it I want you
to hear he wants to give me less and
make me think it’s more when a candidate
tells you that Medicare for all is too
expensive when despite saving lives it
would cost less I want you to hear they
want to give me less
make me think it’s more and when a
candidate is asked do you support
Medicare for all and they answer I
support a lot of plans I want you to
hear that candidate wants to give me
less and make me think it’s more now why
would we want that why would we not want
to have what we need and know in advance
what it is there is no reason in this
world not to support Medicare for all
and every reason to support it now there
is one ideological reason I have to be
perfectly honest which is that Medicare
for all gives Democratic control to a
large segment of the economy that has
been operating in secret largely for the
private enrichment of a few now if
ideologically you believe that’s the way
the world ought to work if you’re a
libertarian if you think the private
executives somewhere should have the
right to make life-and-death decisions
about you and your family yes by all
means you should support Medicare for
all everybody else I mean he should
oppose Medicare for all everybody else
of course should support it

The American Medical System Is One Giant Workaround

From Obamacare to nurses stockpiling medicine, health care has become a jury-rigged mess.

The nurses were hiding drugs above a ceiling tile in the hospital — not because they were secreting away narcotics, but because the hospital pharmacy was slow, and they didn’t want patients to have to wait. I first heard about it from Karen Feinstein, the president and chief executive of the Jewish Healthcare Foundation, who reported it at a board meeting several years ago. I wasn’t surprised: Hiding common medications is a workaround, an example of circumventing onerous rules to make sure patients get even basic care.

Workarounds are legion in the American health care system, to the extent that ECRI (formerly the Emergency Care Research Institute) listed them fourth among its list of top 10 patient safety concerns for health care organizations in 2018. Workarounds, the group writes, are an adaptive response — or perhaps one should say maladaptive response — to “a real or perceived barrier or system flaw.”

Staff use workarounds because they save valuable time. According to Anita Tucker, a business professor at Boston University, system breakdowns, or what she calls “operational failures,” and the workarounds they stimulate, can “consume up to 10 percent of a nurse’s day.” Most hospital nurses are stretched to their limits during their 12-hour shifts. No nurse has 90 minutes to lose to a slow pharmacy or an inefficient hospital bureaucracy.

I saw the common sense that can underlie workarounds when my hospital floor instituted bar code scanning for medication administration. Using a hand-held scanner to register bar codes on medications and patients’ hospital bracelets sounds smart. But then some medications routinely came without bar codes, or had the wrong bar codes, and we nurses weren’t given an easy way to report those errors. Patients’ wrist bands could be difficult to scan and the process disturbed them, especially if they were asleep. The lists of medications on the computer screen were also surprisingly hard to read, which slowed everything down.

But the biggest problem was that the scanning software did not work with our electronic medical records — so all drugs had to be checked off in both systems. This is a huge problem when dealing with patients like those receiving bone-marrow transplants, who might get 20 drugs every morning — some of which are delivered through IVs and come with nonstandard doses. What was already a lengthy process suddenly took twice as long.

Some nurses responded to the arrival of the bar code system with workarounds, including refusing to use the scanner, or taping copies of patient bar codes to their med carts. I tried to adhere to the rules, but if I was especially busy or couldn’t get a medication to scan, I would chuck the whole process.

However, because bar code scanning has been shown to reduce errors in medication administration, the hospital officials wanted it to be done consistently. They produced a public list of all the nurses on the floor. Each nurse was labeled green, yellow or red, depending on the percentage of medications he or she administered using bar codes. Family members, doctors — anyone could see how a nurse was graded.

Over time the list worked, but the sting of it also endured. We were being punished for taking time for patients, even if it meant bending the rules. No one among the managerial class seemed to understand that nurses care a lot about patient safety. The unheard concern was that a green light for bar code scanning meant a patient could fall into the red zone for something else.

Workarounds in health care always involve trade-offs like this, and often they are trade-offs of values. Increasingly, the entire health care system is built on workarounds — many of which we don’t always recognize as such.

Consider the use of medical scribes, who complete doctors’ electronic paperwork in real time during patient visits. The American College of Medical Scribe Specialists reported that 20,000 scribes were working in 2014, and expects that number to climb to 100,000 in 2020.

I have heard doctors say they need a scribe to keep up with electronic medical records, the mounting demand of which is driving a burnout epidemic among physicians. Scribes allow doctors to talk with and examine patients without having a computer come between them, but at base they are a workaround for the well-known design flaws of electronic medical records.

As a nurse, when I first learned about scribes, I was outraged. On the job, nurses hear repeatedly how health care companies can’t afford to have more nurses or aides to work with patients on hospital floors — and yet, money is available to pay people to manage medical records. Doctors who use scribes tend to see their productivity and work satisfaction increase, but the trade-off is still there: Scribes demonstrate the extent to which paperwork has become more important than patients in American health care.

The Affordable Care Act, which I support because it has made health care available to millions of previously uninsured Americans, is also an enormous workaround. The act expanded Medicaid, protected patients with pre-existing conditions and offered subsidies to make private insurance more affordable. Obamacare, though, was never intended to make sure that all Americans had affordable care; it works around our failure to provide health care to all our citizens. In its own way, the Affordable Care Act is as jury-rigged as using ceiling tiles to stash medications.

The United States spends more per person on health care than any other industrialized country, yet our health outcomes, including overall life expectancy, are worse. And interventions like bar code scanning are a drop in the bucket when it comes to preventable medical mistakes, which are now the third-leading cause of death in the country. Our health care nonsystem is literally killing us.

As the workarounds accumulate, they reveal how fully dysfunctional American health care is. Scribes are workarounds for electronic medical records, and bar code scanning is a workaround for our failure to put patient safety anywhere near the top of the health care priority list. It’s a values trade-off that the nurses on my floor instinctively understood.

There Are Really Two Distinct White Working Classes

One is solidly Republican and will stay that way; the other leans Democratic. And then there are the in-betweeners.

At Nancy Pelosi’s news conference last week, a reporter asked her about Joe Biden’s comments on his congenial dealings in the senate of the 1970s with the Southern Democrats James O. Eastland and Herman Talmadge, who were both staunch opponents of Civil Rights legislation and racial integration:

There’s been a back‑and‑forth between Vice President Biden and some of the candidates. Do you think that it is helpful to the party to sort of fight that fight over who best represents the party when it comes to sensitivities about race?

“That’s not what this election is about,” Pelosi answered in a severe tone. “This election is about how we connect with the American people, addressing their kitchen table needs.”

Reporters continued to press Pelosi: “What do you think about Vice President Biden’s words, referencing his work with segregationists and talking about his idea of civility?”

She shot back: “I have answered that question, and that’s all I’m going to say.”

The intensity of the exchange shows how determined key Democratic leaders are to keep the party focused on the bread-and-butter issues of jobs, health care and financial stability and to shore up the gains the party made in 2018, especially among whites.

Pelosi’s response illustrates the deep fear among the same leaders that the agenda could shift to issues of race and immigration. These are issues that a cadre of newly elected progressive members of Congress including Alexandria Ocasio-Cortez, Ilhan Omar, Rashida Tlaib and Ayanna Pressley — as well as Democratic presidential candidates like Elizabeth Warren, Kamala Harris and Cory Booker, all with warmly enthusiastic followings — have brought to the fore. Race and immigration are just the issues Donald Trump and his Republican allies want to place front and center in 2020.

Underlying this is the recognition by many Democratic strategists of the continuing political centrality of less highly educated white voters. Marginal shifts in partisan balloting by the white working class have been a crucial determinant in the outcome of elections since 1968.

This non-college white constituency — pollster shorthand for both the white working class and the white middle class without college degrees — makes up a massive bloc of the electorate, with estimates ranging from 48 percent of the entire electorate in 2016, according to an analysis by Catalist, a liberal voter research group, to 54 percentaccording to the Cooperative Congressional Election Study.

Pete Brodnitz, founder and president of Expedition Strategies, a Democratic polling firm that has performed studies for the Democratic House Majority PAC, wrote by email that in 2018 he found that the white working class could be divided into five political categories:

  1. reliably Democratic, 33 percent;
  2. lean Democratic, 7 percent;
  3. true independents, 10 percent;
  4. lean Republican, 7 percent; and
  5. reliably Republican, 44 percent.

How each of these categories voted in 2016 shows the importance of these distinctions. In a poll of battleground House Districts, Hillary Clinton carried the reliably Democratic base by a solid 67-point margin (78-11) and the lean Democrats by 61 points (64-3). She lost the true independents by 16 percentage points (21-37). Trump won overwhelmingly among the lean Republican whites (73-12, a 61-point margin) and the solid Republicans by 84 points (88-4), according to the data collected by Expedition Strategies working with Normington/Petts, another Democratic polling firm.

In almost every way, white non-college Democrats and white non-college Republicans are nothing alike,” Michael Podhorzer, the political director of the AFL-CIO, emailed in response to my inquiry.

Polling conducted by GQR, a Democratic firm, for the AFL-CIO, found that among the Republican white working class, 79 percent identify as Christian, two thirds of whom are evangelical or born again. Among the Democratic non-college electorate, 44 percent said they were Christian, and one third of them said they were evangelical or born again.

The Democrats are much younger, according to Podhorzer: 22 percent are Gen Z or Millennial compared with 12 percent of working class white Republicans. The Democratic members of the white working class are 59 percent female and 41 percent male, compared with 51 percent female, 49 percent male among Republican non-college whites.

Perhaps most important, the white non-college Republican and Democratic constituencies differ radically on policy and political beliefs.

Take favorability ratings of

  • Obamacare,
  • Black Lives Matter and
  • Medicare for all.

Among working class white Democrats, the ratings are uniformly positive, according to AFL-CIO data: 89 percent, 80 percent and 85 percent. Among their white Republican counterparts, the ratings are uniformly dismal: 5 percent, 9 percent and 18 percent.

What this data shows is that Democrats should have little trouble retaining the support of members of the white working class who identify as Democrats, but they will struggle mightily to win over their Republican counterparts.

This divide leaves the small percentage of the white working class whose views put them in the middle ground between left and right up for grabs and likely to determine the outcome in 2020.

The AFL-CIO survey suggests that the roughly 10 percent of non-college whites who do not identify with either party may be reachable for Democratic candidates, but there are big hurdles.

For one thing, these self-described independents do not side with mainstream Democrats on the kinds of incendiary issues that President Trump loves to promote.

The AFL-CIO study examined four categories of voters: all Democrats; non-college white Democrats; independent non-college whites; and Republican non-college whites.

The survey asked, for example, whether voters agree or disagree with the statement “Social and economic problems in this country are largely due to individuals across races and origins refusing to work and expecting handouts.”

All Democrats, including white non-college Democratic respondents, took liberal stands, sharply disagreeing with the statement by 62 points (78-16) and 56 points (76-20). Independent voters in the white working class were in favor by 11 percentage points (52-41), and Republican respondents were solidly in agreement, by 72 points (84-12).

On a similar racially freighted question — “Social and economic problems in this country are largely due to certain groups failing to work hard and play by the rules” — Democrats disagreed by large margins, while independent white non-college voters showed greater conservatism, agreeing 54-36; Republican non-college whites strongly agreed, 79-12.

The accompanying graphic shows the pattern of opinion on three additional questions measuring what sociologists call “anti-black affect.”

A Partisan Chasm on Race

Less-educated white Democrats largely agree with Democrats overall, but the views of independents and Republicans are the reverse. Percentage of respondents to a 2018 survey who agreed or disagreed with these statements.

AGREE: White people in the U.S. have certain advantages because of the color of their skin.

ALL DEMOCRATS

83%

76

DEM.

WHITES WITH

NO COLLEGE

29

IND.

17

REP.

AGREE: Generations of slavery and discrimination have created conditions that make it difficult for African-Americans to work their way out of the lower class.

ALL DEMOCRATS

73

69

DEM.

WHITES WITH

NO COLLEGE

24

IND.

8

REP.

DISAGREE: Ethnic groups like the Irish, Italian, Jewish and many other minorities overcame prejudice and worked their way up. Blacks should do the same without any special favors.

ALL DEMOCRATS

57

49

DEM.

WHITES WITH

NO COLLEGE

14

IND.

4

REP.

By The New York Times | Source: Polling Consortium Election Survey conducted Oct. 24–Nov. 7

The next accompanying graphic illustrates hostility toward immigrants — or acceptance.

Democrats Stand Alone on Immigration

Percentage of respondents who disagreed with these two statements.

DISAGREE: Increase border security by building a fence along part of the U.S. border with Mexico.

ALL DEMOCRATS

80%

DEM.

82

WHITES WITH

NO COLLEGE

IND.

28

REP.

3

DISAGREE: Deport undocumented immigrants to their native countries.

ALL DEMOCRATS

56

DEM.

55

WHITES WITH

NO COLLEGE

IND.

14

REP.

1

By The New York Times | Source: Polling Consortium Election Survey conducted Oct. 24–Nov. 7

The AFL-CIO survey demonstrate why liberal Democratic leaders like Pelosi are resolved to stand clear of some of the issues that divide their party from independents. At the same time, it shows why Pelosi and others want to focus on so-called kitchen table issues.

On health care and economic matters, there is far more overlap between the views of Democrats as a whole and independent white working class voters.

Support for a tax on wealth in excess of $100 million tops 90 percent among Democrats, while white working class independents support such a proposal 59-25.

A proposal supported by Democrats of all stripes — “Having the government produce generic versions of lifesaving drugs, even if it required revoking patents held by pharmaceutical companies” — has the backing of non-college white independents, 56-25.

By two to one, white independents agreed with two liberal populist statements: that “social and economic problems in this country are largely due to a handful of wealthy and powerful people rigging the rules to their advantage” and that “social and economic problems in this country are largely due to a handful of wealthy and powerful people dividing us against each other so they can take more for themselves.”

Two proposals backed by some of the Democratic presidential candidates — Abolish ICE and Medicare for All — do not sell well among white non-college independents, who opposed the two initiatives by 71-15 and 48-31.

Podhorzer argues that in the 2020 battleground districts and states the contest will be fought over the 13 percent who are swing voters, a group he calls “partisan bystanders.” He described them as “voters who either have a very negative view of both parties or do not have strong feelings about either party. These voters favored Democrats in the 2018 midterms by 11 points after favoring Trump by 6 points in 2016.”

According to Podhorzer, almost half (46 percent) of the partisan bystanders are “white non-college, so this group, especially white non-college women, is going to be a battleground for both campaigns.”

Podhorzer makes a key point: In his view, this 13 percent is receptive to Democratic appeals because they

are looking for answers to the basic economic challenges they face. That issues like health care are much more important to them makes sense given that just about everyone who cares about issues like immigration has already picked sides and won’t be moved.”

In some respects, the AFL-CIO poll provides ammunition to the Third Way, a centrist Democratic advocacy group.

Jonathan Cowan, president and co-founder of Third Way, argued in an email that:

Going forward to 2020, there are lines that Democrats can’t cross if they want to win nationally and hold the House and gain in the Senate. Medicare for All is one of those lines. But there are others like abolishing ICE, a guaranteed federal job, and certain climate proposals that ignore the economic circumstances of the interior of the country.

Third Way survey of Democratic primary voters, conducted in May by David Binder Research, found that calls to abolish ICE in particular are problematic. In fact, Democratic presidential candidates are backing away from their earlier support of the idea, despite the horror show that is happening on the border right now.

The Third Way poll found that Democratic voters of all stripes prefer a candidate who promises to expand employment opportunity to one who would guarantee everyone a government job; and these voters prefer a candidate who would ensure “that every student who enters college can finish with a degree” to one “who supports free 4-year college for all students.”

In the case of health care, the Third Way survey of Democratic primary voters found that a plurality, 42.9 percent, preferred a candidate “who wants an annual cap that limits the costs people pay while making sure everyone has insurance coverage” while 35.2 percent prefer a candidate “who wants to pass a single-payer, Medicare for All government-run plan.”

Both Democratic and Republican strategists are putting all of these findings under a microscope because in a highly competitive election, seemingly small shifts can determine the outcome.

ADVERTISEMENT

Take the difference between Hillary Clinton’s performance in 2016 and the performance of House Democratic candidates.

In 2016, all non-college whites went 60-34 for Trump over Clinton, while voting 58-38 in favor of Republican House candidates, according to Brian Schaffner, a political scientist at Tufts and senior researcher at the Cooperative Congressional Election Study.

This may seem insignificant, but if Clinton had been able to match the margin of Democratic House candidates, not only would she have picked up 2.9 million votes nationwide, she would have won Michigan, Pennsylvania and Wisconsin by a combined total of 383,000 votes instead of losing them by a total of 79,646 votes.

One interpretation of Democratic success in taking control of the House in 2018 suggests a strategy of moderation, while using animosity to Trump to boost turnout in hard core Democratic constituencies, including among minorities, young voters and single women. If the 2018 House give hints on the type of voters who offer the best targets for 2020, it is worth recalling that more than three quarters of the newly Democratic seats are in centrist districts.

According to data provided by Third Way, the new Democratic districts are predominately upscale, with higher than average percentages of well-educated, well-off whites and lower than average percentages of less-well-off whites.

However, the demographics of these districts mask the significant gains Democrats made in 2018 among non-college, less affluent whites. This becomes clear in an analysis of the 2018 election by Yair Ghitza, chief scientist at Catalist.

“There has been a lot of attention paid to the Democratic victories in suburban areas, but we find that Democratic gains were actually largest in rural areas,” Ghitza wrote:

These gains weren’t enough to get over 50 percent and win seats in many rural districts, so they have escaped much of the mainstream election analysis to this point. These changes are nonetheless important, particularly because they were large in many of the Midwest battleground states that will no doubt be important in 2020.

Ghitza provided further support for the Democratic strategy of going after white non-college voters by noting that 2018 Democratic gains were “largely driven by voters who voted for Trump in 2016 and voted Democratic in 2018.”

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It is no wonder, then, that Pelosi is not the only party leader warning Democrats to be wary of the danger of focusing too much on social and cultural issues in the heat of the primaries. Such counsel also comes from African-American Democrats.

Take Representative Cedric Richmond of Louisiana, who suggested to the Washington Post last week that there should be less attention paid to Biden’s stumble on race: “African-Americans are worried about the safety of their families. They’re worried about jobs. They’re worried about health care, diabetes, cancer, and they’re worried about how to pay for kids’ college.”

Richmond was joined by Representative John Lewis, who said he didn’t think Biden’s remarks were “offensive,” before adding, “During the height of the civil rights movement we worked with people and got to know people that were members of the Klan — people who opposed us, even people who beat us, and arrested us and jailed us.”

The Rev. J.M. Flemming, president of the Greenville NAACP, told the Washington Post:

“I’m not going to let anybody sidetrack folks that I know about who are looking at Biden, when we ought to be looking at the things said by Trump. Nobody is making anybody out to be a perfect person, but what Trump is doing, for me, that’s far worse.”

The concerns of African-Americans, in this view, are substantially the same as the concerns of the millions of white working class voters who remain open to Democratic candidates — or at least they coincide in critically important ways.

The fate of the Democratic Party in 2020 hangs on this premise and on a united resistance to Trump’s malign strategy of divide and conquer.