Liberaltarians

The conservative movement—and, with it, the GOP—is in disarray. Specifically, the movement’s “fusionist” alliance between traditionalists and libertarians appears, at long last, to be falling apart.

.. Libertarian disaffection should come as no surprise. Despite the GOP’s rhetorical commitment to limited government, the actual record of unified Republican rule in Washington has been an unmitigated disaster from a libertarian perspective: runaway federal spending at a clip unmatched since Lyndon Johnson; the creation of a massive new prescription-drug entitlement with hardly any thought as to how to pay for it; expansion of federal control over education through the No Child Left Behind Act; a big run-up in farm subsidies; extremist assertions of executive power under cover of fighting terrorism; and, to top it all off, an atrociously bungled war in Iraq.

This woeful record cannot simply be blamed on politicians failing to live up to their conservative principles. Conservatism itself has changed markedly in recent years, forsaking the old fusionist synthesis in favor of a new and altogether unattractive species of populism.

.. The old formulation defined conservatism as the desire to protect traditional values from the intrusion of big government; the new one seeks to promote traditional values through the intrusion of big government.

.. Just look at the causes that have been generating the real energy in the conservative movement of late: building walls to keep out immigrants, amending the Constitution to keep gays from marrying, and imposing sectarian beliefs on medical researchers and families struggling with end-of-life decisions.

.. the conservative embrace of a right-wing Leviathan has left libertarian-minded intellectuals feeling left out in the cold.

.. New York Post columnist Ryan Sager bemoaned the rise of big-government conservatism and warned that excessive pandering to evangelicals would rupture the movement.

.. Andrew Sullivan denounced the right’s fundamentalist turn in The Conservative Soul: How We Lost It, How to Get It Back.

.. 13 percent of the population, or 28 million voting-age Americans, can be fairly classified as libertarian-leaning.

.. Back in 2000, this group voted overwhelmingly for Bush, supporting him over Al Gore by a 72-20 margin.

.. Markos Moulitsas of Daily Kos fame caused something of a stir by proposing the term “Libertarian Democrat” to describe his favored breed of progressive.

.. Governor Brian Schweitzer of Montana, fellow Montanan Tester, and Virginia Senator-elect Jim Webb—have sounded some libertarian themes by being simultaneously pro-choice and pro-gun rights.

.. if Democrats hope to continue appealing to libertarian-leaning voters, they are going to have to up their game. They need to ask themselves: Are we content with being a brief rebound fling for jilted libertarians, or do we want to form a lasting relationship? Let me make a case for the second option.

.. the prevailing ideological categories are intellectually exhausted. Conservatism has risen to power only to become squalid and corrupt, a Nixonian mélange of pandering to populist prejudices and distributing patronage to well-off cronies and Red Team constituencies.

.. Liberalism, meanwhile, has never recovered from its fall from grace in the mid-’60s.

.. Conservative fusionism, the defining ideology of the American right for a half-century, was premised on the idea that libertarian policies and traditional values are complementary goods.

.. But an honest survey of the past half-century shows a much better match between libertarian means and progressive ends.

.. many of the great libertarian breakthroughs of the era—the fall of Jim Crow, the end of censorship, the legalization of abortion, the liberalization of divorce laws, the increased protection of the rights of the accused, the reopening of immigration—were championed by the political left.

.. capitalism’s relentless dynamism and wealth-creation—the institutional safeguarding of which lies at the heart of libertarian concerns—have been pushing U.S. society in a decidedly progressive direction.

.. The civil rights movement was made possible by the mechanization of agriculture, which pushed blacks off the farm and out of the South

.. Likewise, feminism was encouraged by the mechanization of housework.

Greater sexual openness, as well as heightened interest in the natural environment, are among the luxury goods that mass affluence has purchased.

.. secularization and the general decline in reverence for authority, as rising education levels (prompted by the economy’s growing demand for knowledge workers) have promoted increasing independence of mind.

.. Yet progressives remain stubbornly resistant to embracing capitalism, their great natural ally.

.. Knee-jerk antipathy to markets and the creative destruction they bring continues to be widespread, and bitter denunciations of the unfairness of the system, mixed with nostalgia for the good old days of the Big Government/Big Labor/Big Business triumvirate, too often substitute for clear thinking about realistic policy options.

.. the rival ideologies of left and right are both pining for the ’50s. The only difference is that

  • liberals want to work there, while
  • conservatives want to go home there.

.. Both generally support a more open immigration policy. Both reject the religious right’s homophobia and blastocystophilia. Both are open to rethinking the country’s draconian drug policies. Both seek to protect the United States from terrorism without gratuitous encroachments on civil liberties or extensions of executive power. And underlying all these policy positions is a shared philosophical commitment to individual autonomy as a core political value.

.. their conceptions differ as to the chief threats to that autonomy.

  • Libertarians worry primarily about constraints imposed by government, while
  • liberals worry most about constraints imposed by birth and the play of economic forces.

.. At the same time, some of the resulting wealth-creation would be used to improve safety-net policies that help those at the bottom and ameliorate the hardships inflicted by economic change.

.. Progressive organizations like Oxfam and the Environmental Working Group have already joined with free-market groups in pushing for ag-policy reform.

.. the current subsidy programs act as a regressive tax on low-income families here at home while depressing prices for exporters in poor countries abroad—and, to top it off, the lion’s share of the loot goes to big agribusiness, not family farmers.

.. the president of Cato and the executive director of the Sierra Club have come out together in favor of a zero-subsidy energy policy.

.. cut taxes on savings and investment, cut payroll taxes on labor, and make up the shortfall with increased taxation of consumption. Go ahead, tax the rich, but don’t do it when they’re being productive. Tax them instead when they’re splurging—by capping the deductibility of home-mortgage interest and tax incentives for purchasing health insurance. And tax everybody’s energy consumption.

.. Gore has proposed a straight-up swap of payroll taxes for carbon taxes

.. Greg Mankiw has been pushing for an increase in the gasoline tax.

.. libertarians’ core commitments to personal responsibility and economy in government run headlong into progressives’ core commitments to social insurance and an adequate safety net.

.. Spending on Medicare, Medicaid, and Social Security is now projected to increase from about 9 percent of GDP today to approximately 15 percent by 2030.

.. We can fund the Earned Income Tax Credit and other programs for the poor; we can fund unemployment insurance and other programs for people dislocated by capitalism’s creative destruction; we can fund public pensions for the indigent elderly; we can fund public health care for the poor and those faced with catastrophic expenses. What we cannot do is continue to fund universal entitlement programs that slosh money from one section of the middle class (people of working age) to another (the elderly)—not when most Americans are fully capable of saving for their own retirement needs.

.. Instead, we need to move from the current pay-as-you-go approach to a system in which private savings would provide primary funding for the costs of old age.

The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy

I focus on issues surrounding the promotion and marketing of controlled drugs and their regulatory oversight. Compared with noncontrolled drugs, controlled drugs, with their potential for abuse and diversion, pose different public health risks when they are overpromoted and highly prescribed. An in-depth analysis of the promotion and marketing of OxyContin illustrates some of the associated issues.

.. When Purdue Pharma introduced OxyContin in 1996, it was aggressively marketed and highly promoted. Sales grew from $48 million in 1996 to almost $1.1 billion in 2000. The high availability of OxyContin correlated with increased abuse, diversion, and addiction, and by 2004 OxyContin had become a leading drug of abuse in the United States.

.. The promotion and marketing of OxyContin occurred during a recent trend in the liberalization of the use of opioids in the treatment of pain, particularly for chronic non–cancer-related pain. Purdue pursued an “aggressive” campaign to promote the use of opioids in general and OxyContin in particular., In 2001 alone, the company spent $200 million in an array of approaches to market and promote OxyContin.

.. From 1996 to 2001, Purdue conducted more than 40 national pain-management and speaker-training conferences at resorts in Florida, Arizona, and California. More than 5000 physicians, pharmacists, and nurses attended these all-expenses-paid symposia, where they were recruited and trained for Purdue’s national speaker bureau.(p22) It is well documented that this type of pharmaceutical company symposium influences physicians’ prescribing, even though the physicians who attend such symposia believe that such enticements do not alter their prescribing patterns.

..One of the cornerstones of Purdue’s marketing plan was the use of sophisticated marketing data to influence physicians’ prescribing. Drug companies compile prescriber profiles on individual physicians—detailing the prescribing patterns of physicians nationwide—in an effort to influence doctors’ prescribing habits. Through these profiles, a drug company can identify the highest and lowest prescribers of particular drugs in a single zip code, county, state, or the entire country. One of the critical foundations of Purdue’s marketing plan for OxyContin was to target the physicians who were the highest prescribers for opioids across the country.,, The resulting database would help identify physicians with large numbers of chronic-pain patients. Unfortunately, this same database would also identify which physicians were simply the most frequent prescribers of opioids and, in some cases, the least discriminate prescribers.

.. A lucrative bonus system encouraged sales representatives to increase sales of OxyContin in their territories, resulting in a large number of visits to physicians with high rates of opioid prescriptions

.. In 2001, in addition to the average sales representative’s annual salary of $55 000, annual bonuses averaged $71 500, with a range of $15 000 to nearly $240 000.

.. Purdue paid $40 million in sales incentive bonuses to its sales representatives that year.

.. A consistent feature in the promotion and marketing of OxyContin was a systematic effort to minimize the risk of addiction in the use of opioids for the treatment of chronic non–cancer-related pain.

.. Purdue trained its sales representatives to carry the message that the risk of addiction was “less than one percent.

Trump ignores his own commission’s advice on opioids

After an appropriate nod to prevention, which is indeed a potentially efficient means of stemming the epidemic, Mr. Trump launched an extended attack on his predecessor’s record, accusing President Barack Obama’s administration of having reduced drug prosecutions and failing to achieve longer sentences in those drug-related cases it won.

.. For much if not most of the Obama presidency, users obtained opioids through legal channels — starting with doctor prescriptions. At least Mr. Obama’s administration sought to clamp down on that through tightened national prescribing guidelines late in his term.

The Secret to My Success? Antidepressants

Many of my favorite authors had suffered from anxiety or depression — Dostoyevsky, Fitzgerald, Plath, Woolf and Emily Dickinson, with whom I felt a special migraine-sufferer kinship. I sought out biographies of these tortured artists and underlined the details of their suffering until the pages were covered in multicolored highlighter. Surely, I told myself, their anguish was linked to their greatness. Instead of fleeing anxiety and depression (although many did douse their emotional instability with alcohol), they dived in and used their misery as inspiration for their creative work. I was convinced that killing the mad part of me with medication would also kill that which made me unique. I memorized a line by Proust: “Happiness is beneficial for the body, but it is grief that develops the powers of the mind.”

.. In fact, I am more myself than ever, able to tap veins of creativity and insight I never knew existed, once buried under the clamor of anxiety. My writing, too, was born again. Glimmers of redemption sprang in my dark, and often tragic, stories. I can now see the infinite spectrum of emotion in all its nuanced hues, not just the black and white of despair and joy.