$2.7 trillion per year is a lot of money and healthcare inflation is high (at least 6% annually.) That's what we are annually spending on healthcare in this country. By total dollars and by percentage of GDP, we are spending more than anyone else in the world on healthcare. Furthermore, on most metrics, we rank far behind many other developed countries with regards to health. It does not sound like a bargain - shouldn't we be able to provide coverage for everyone and/or have better results?

 

Other countries run on basically a Medicare model of care, ensuring that all have healthcare coverage, while limiting the knee-jerk use of expensive tests and interventions. In medicine, we call this "conservative management."

 

The U.S. is like no other country in the world. We rely upon private insurers to pay for a large amount of care (about 45% of individuals have private insurance.) The goal of the private insurers is to make money. They do this by reducing their payouts whenever possible. This means insuring only healthy individuals, excluding "sick" individuals (or making them pay much higher premiums), and avoiding paying for as much care delivered as possible.

 

Private insurers are expensive and inefficient. Using data from the California Department of Managed Care, private health insurance companies regulated by the department spend $6 billion each year on administration, and divert an additional $4.3 billion to profit (approximately 25% of the moneys that they gather.) Measuring the administrative costs in the public insurance entities is much lower, but by how much is unknown (some say admin costs are on the order of 2 to 4%.)

 

What we want in our healthcare proposals are

The Debates:

 

It seems clear that Obama's style is more Akido than boxing. I would say Hillary Clinton is a kind of Mix Martial Artist of debates. She will throw elbows, knees and anything to win. Obama seems to have learned a style that works for him and his message. He does not want to portray himself as angry, or a partisan fighter, so he dodges and parries attacks and uses the force of the attack to make his opponent appear off balance, hence the Akido. When McCain was most attacking Obama's calm deflection made McCain look undisciplined and perhaps erratic. It must on some level be maddening to debate someone who won't get down in the muck. But I think the price Obama paid with Clinton for the "She's likable enough," comment taught him a lesson. Stay above it, don't try to stick the knife in, win on points and never ever, go for a knockout.

 

Another point, I find McCain's argument in the debate to be horribly anachronistic almost to the point of demagoguery. Railing against tax and spend liberalism seems surreal when you and your party just voted for a 700 billion dollar bail out of Wall Street. Republicans have exploded the deficit and I thought Obama missed the opportunity to say that someone has to pay for the two wars we are fighting. The argument is essentially this; McCain wants to continue to give tax cuts to the wealthy with the idea that they will use the money to invest and create jobs. Obama wants to shift a bit of the balance of the burden upward in order to allow middle and lower income Americans to overcome stagnating wages and stimulate demand. Either way there are deficits for as far as the eye can see and I have not heard any sensible economist who does not think we need to use government spending and deficit spending to help fight a deeper recession. There is an argument that government spending takes too long as stimulus but that's why you use the tax code, and perhaps another rebate check to stimulate demand. If consumers stop spending investors will continue to put their money in safe securities and not invest in expansion. The problem with trickle down in our current situation is the wealthy don't have to take the risk. They can hold on to their money until they feel demand returns. Increased income for lower and middle-income Americans leads to direct increases in consumption. They have day-to-day needs to fulfill. The wealthy don't have to by an extra Bentley and likely won't in tough times.

 

That being said as a political scientist I was struck at how the positive assessment of McCain's debate performance came largely from his aggressive recitations of partisan orthodoxy and issues like taxes, spending (do as we say not as we do), and abortion. It seemed Republican and Democratic commentators alike gave him points for being on the attack and for clearly reciting these points. But it seems the voters have tuned them out. What sense does it make to rail against spending when you just voted for a 700 billion dollar bailout and are proposing another 300 billion dollars? A cool one trillion dollars in spending, while maintaining tax cuts, continuing the war in Iraq and all the while railing against spending struck me as a bit strange. McCain presented some solid and very sensible policies during the week like preventing forced divestment for seniors and perhaps expanding unemployment benefits and cutting taxes on those benefits. He could have mirrored some kind of tax credit for small businesses and Obama's call to extend small business loans. In short, he could have trended toward the center. In short, McCain's argument is now that we should spend 1 billion dollars to bailout Wall Street and buy up bad mortgages and tax people making under $250,000 a year in order to pay for it or not pay for it at all. Beyond that how do we plan to pay for McCain's open-ended commitment in Iraq?

 

Powell's Endorsement:

 

Colin Powell's endorsement was for me one of the most interesting moments of the campaign. He made the most clear and unequivocal endorsement of the campaign. Its candor was stunning in terms of its indictment of the party and its clear praise of Obama. One point that struck me was how clear and powerful his endorsement was in contrast to the Clinton's. Also the way he handled the issue of racially and religious bigotry.

 

See the endorsement and also a wonderful commentary by Princeton Political Scientist Melissa Harris-Lacewell.

Colin Powell's endorsement of Barack Obama on Sunday will surely continue to draw media attention - at least through Tuesday. It seems unlikely though, that the endorsement will actually make a difference. There is not much political science evidence that endorsements matter in the general election. However, I don't think you need to be a political scientist to see why the endorsement probably won't matter. In fact, I think it will matter as much as all the other single campaign events that might seem to matter, but probably don't: debates, conventions, advertisements. I think there is actually a simple way to get a good idea of whether those single events will matter: ask yourself, do you know anyone that changed their vote because of it? Maybe it matters to those all important "undecided voters." To the extent that undecided voters exist, I doubt such events matter for them either.

 

Think about it this way: who do you know that watched the debates? I bet they are pretty politically aware people, right? Do any of those politically aware people really still not support a candidate? The same is true of Powell's endorsement. Who do you know that would care - that doesn't already have a horse in the race?

 

We are always told that these events matter to those undecided voters. I doubt this is true. I doubt that many exist, and if they do, no single event should matter to them. It is always bad to use anecdote as scientific evidence. But my scepticism about the importance of undecided voters comes from this simple fact: I don't know any undecided voters. Maybe I need to get out of the ivory tower, but outside of the realm of anecdote - there is good political science evidence that most people that care a good deal about elections and politics, hold strong opinions about elections and politics. This is the contradiction - if you are paying attention enough to be aware of the events that are supposed to change your mind, you probably are not susceptible to having your mind changed.

 

The LA Times referred to the Powell endorsement as "potent." If one wants, I am sure that they will be able to find evidence that it was so - for example, I bet Obama's lead will have risen in the next poll: but a look at the numbers shows that his lead has been steadily rising for several weeks. Are more undecided voters becoming decided? Maybe, but I think it is more likely they are now just expressing opinions that they have always held. My guess is that there is a certain celebration of the idea of being "independent" and, therefore, "undecided" in our political discourse. At some point though, being undecided starts to look more like being uninformed. As election day approaches, being undecided starts to look more and more irresponsible and, my guess, is that voters begin to drop this facade.

 

Now - don't get me wrong - I am sure that some real undecideds exist. But not nearly as many as the inordinate attention paid to them by pundits would lead us to exist. I have a hunch that if the media decided it made sense to pay attention to committed partisans, then we might suddenly have a lot fewer undecideds. Now I just have to convince the media to play along with my experiment.

More years ago than I'd like to admit, I was fortunate enough to land an internship with Late Night with David Letterman on NBC. Although interns on the show were-literally-forbidden to speak with the host unless first spoken to, I'd like to think I got a fairly good insight into the "real" David Letterman during my summer there.

 

Because of that experience, I have been particularly interested to watch the developing feud between Letterman and John McCain over the past few weeks. When McCain bailed on Letterman at the last moment to "return to Washington" during the early days of the current economic crisis, he clearly irked Letterman. But when it became clear that McCain had, in fact, remained in New York City and instead chosen to be interviewed by Katie Couric of the CBS Evening News, Letterman went ballistic, excoriating McCain during that (and nearly every subsequent) show for his deception.

 

In my observation of Letterman over the years, it seems clear to me that Letterman is generally apolitical and nonpartisan in his core temperament. Like many people who aren't deeply ideological or obsessive about politics, he also seems to be prone to generalizing based on observation of anecdotes or personal characteristics. Letterman also appears to despise pretension and arrogance. Quite of bit of what led to Letterman's early reputation as a "mean" interviewer seems to have been based on his hostile reaction to guests that seemed to be displaying one or both of these characteristics. By canceling his appearance at the last minute (apparently under false pretenses), McCain blundered into a perfect storm of Lettermania, and has been paying the price since.

 

McCain's appearance on Thursday night's show was an attempt to stop the bleeding. His initial response to Letterman's hectoring ("I screwed up") was a good start, but the highly confrontational tone of the interview was another repercussion of McCain's mistake. And from the questions asked, it seemed clear to everyone that Letterman has concluded that McCain chose an unqualified running mate and that his campaign's attacks on Obama's association with William Ayers.

 

Despite the hostility of the interview, however, it appears McCain helped his flagging campaign with the appearance. My colleague Matthew Baum has noted in several articles on "soft news," appearances on such programs are one of the best ways to reach inattentive or relatively apolitical viewers (see here and here for examples). In a campaign in which the party faithful are being exceptionally, well, faithful to their respective candidates, McCain must fight tooth and nail for the votes of independents and undecided voters. Soft news or interview programs like Letterman are golden opportunities to reach such voters: They are disproportionately likely to watch such shows, versus traditional news programs, and the content of such programs are likely to be more engaging and interesting to viewers who typically tune out politics. It's also likely no accident that both McCain and Obama placed paid advertisements in the show. McCain's was a minute-long piece that began with an implicit criticism of the Bush Administration's handling of the last eight years-a pretty clear attempt to appeal to moderate voters dissatisfied with the current situation.

 

The interview has also scored a tremendous amount of attention, attracting Letterman's highest ratings in the past few years (ironically, the highest since Letterman had Oprah Winfrey on to settle a previously simmering feud), as well as considerable amount of coverage in other media. Google News, for example, currently links to more than 1,300 related stories about the interview. Combined with Sarah Palin's appearance on Saturday Night Live, it seems clear that the McCain-Palin campaign, which previously attacked Obama's "celebrity," is desperately trying to make their candidates soft news stars.

Like millions of other Americans, the third and last presidential debate on October 15 reinforced our impressions of each candidate, provided additional policy details, and revealed more insights into the character of each. McCain did surprisingly better, in my opinion, than in the previous rounds, playing the aggressive underdog with little to lose. Obama played it cautiously, not unexpected when in the lead, but he did not make a major error. No clear winner.

 

What particularly pleased me was the attention on education. It is heartening to see that both candidates recognize that the nation's future depends on educational investments and improving schools. There were points of agreement during the debate, but there certainly were differences, particularly on vouchers. McCain and Republicans favor greater individual choice that would create market-type pressure on public schools. Obama and Democrats look suspiciously on this approach, due perhaps to the belief that not all individuals can equally benefit from vouchers and that public schools should be reformed rather than endangered. Same concerns but divergent approaches anchored in disparate ideologies about the role of the state and the market.

 

What is disappointing was the lack of attention to vocational education during the debate, particularly given the repeated references to "Joe the plumber." America needs both a well-educated population and a highly skilled labor force. Unfortunately, high-school vocational education is often treated as a residual, failing to receive the attention, respect and resources needed to provide first-class training for those going directly into what some call "the trades."

 

The McCain-Obama exchange highlights that the sad fact that the larger political discourse on post-secondary education has focused on access to college, particularly to the better institutions, at the expense of improving post-secondary vocational education. No doubt, we should have world-class universities, and all should have an equal chance to attend based on ability and interest. This type of education, however, is not necessarily for everyone. The public school system and public higher education provide too little training for "Joe the plumber" and his employees, as well as numerical-control machinists, operators of sophisticated office equipment, and workers in scores of other occupations. The training is not only valuable for those entering the labor market but also for those who must upgrade their skills to keep up with technology and those forced to change jobs and careers. The failure to offer adequate educational opportunities to all segments of the population and labor force makes the United States less productive and therefore less competitive in the global economy. Hopefully the next president will give equal billing to vocational education as an integral and essential component of a well-rounded education policy.

As we continue to speculate about whether Obama's race will affect this election, it is instructive to examine a powerful consequence of race relations in the United States: residential segregation.  The more segregated a state, the less likely white voters are to vote for Obama - and this is not just in the South.

 

 

The figure here shows the relationship between the average segregation of African-Americans at the state level and the vote for Obama among white voters in the Democratic primaries. This is for non-Southern states.  Obama's vote, on the horizontal axis, is measured by exit polls.  Segregation, on the vertical axis is measured by the Dissimilarity Index, which is a measure commonly used by social scientists. The orange vertical line represents the best approximation of the linear relationship between segregation and Obama's white vote.

 

The relationship is strong and very negative.   After controlling for other factors that might be relevant on the state level (median income, conservatism, and percent African-America) the effect is considerable.  Moving from the least segregated state in the sample (Oregon), to the most (New Jersey) predicts a loss of vote for Obama of over 8 points.  If the South is included, moving from Oregon to Mississippi, the most segregated state, loses Obama 19 points.

 

Why is this?  One hypothesis might be that the more contact that whites have with African-Americans, thus the less segregation in a state, the more likely white voters are to support Obama.  This is plausible and would support some long-standing, but very controversial, social science theories.  Presumably if this were true, we would also see the effect of segregation be less when controlling for the proportion of a state that is African-American.  But controlling for this does not lessen the effect of segregation.

 

It is also the case that the measure of segregation is residential segregation.  Residential segregation does not speak to whether  whites have contract with African-Americans during their daily lives in non-residential settings.  I think most of us would imagine that the typical white resident of New Jersey, a highly segregated state, has much greater contact with African-Americans than a white resident of Oregon, a low segregation state.

 

I think it is more likely that the relationship between segregation and not voting for Obama reflects underlying currents of race relations in American society.  It is no accident which states became highly segregated.  These states, like New Jersey, Ohio, Indiana, and Pennsylvania were states that experienced large migrations of African-Americans to their urban cores during the 1940's, 50's, and 60's.  The housing patterns of these states reflect the distaste that the white residents of those states had for sharing their communities with African-Americans.

 

The racially tinged political issues of busing and crime during the 1960's were a reflection of the tension that voters in these states, and many other places, felt while trying to reconcile their long standing political beliefs (most were Democrats) with their changing demographic reality. In fact, this is rather evident when we look at the relationship between the vote for the openly racist George Wallace in 1968 and racial segregation.  The figure here, similar to the one above shows the relationship between segregation and Wallace's share of the 1968 popular vote by state.  Clearly, as segregation increased, so did the vote for Wallace.  In fact, with relevant controls, the effect of segregation is still very large, about twice the size of the effect on Obama's vote.

 

 

My feeling is that some of the same forces that contributed to Wallace's success in 1968 are those that are hurting Obama now.  In fact the correlation between Obama's vote in the primaries and Wallace's 1968 vote is pretty strong (-.527).

 

It is difficult to pinpoint exactly what the exact cause of this relationship may be - Obama and Wallace are separated by 40 years - and there are economic, social, and cultural factors at play.  However, the attitudes that many white Americans have about economic, social, and cultural factors are deeply intertwined with race.   So, while even in 1968, race was not the only reason that some whites voted for the racist Wallace and race will certainly not be the only or primary reason that some whites do not vote for Obama in 2008, we can not ignore the complicated relationship that race has with attitudes about "non-racial" issues.  Moreover, there are individuals in society that are racist enough that racism will affect their vote and some of these people live in these states.

 

It is also likely that the presence of segregation is not only a reflection of racial attitudes, but also reinforces those attitudes.  This probably has political consequences.  White voters may have trouble seeing their future politically tied to groups of people that are literally separated from them.

 

Looking at the plots, you can see that many of the highly segregated states are considered "battleground" states.  It seems likely that segregation, which is partially a reflection of racism and partially a contributor to it, affects the attitudes of some voters in these states.  This may partially be what makes them "battlegrounds."

 

A note on the methodology (some blog readers might not care about this):

 

Obama's primary vote represents the two-candidate vote between Clinton and Obama only.  I did not include the candidates home states of Illinois and New York.  I also excluded Arkansas and Michigan.  There were obviously other factors at play in these states that determined the primary vote outcomes in these states.  Including them weakens the relationship a bit.  The South is considered everything below the Mason-Dixon Line, plus Oklahoma, which is the common practice in political science research.  Controlling for states that held caucuses, rather than actual primaries, does not make a difference in the estimated effect of segregation on Obama support.   For Wallace, the relationship between his support and segregation is more difficult to detect when examining all states at the same time.  It seems that Wallace had a much different appeal to Southerners, Northerners, and Westerners.  The plot included in this post is just the non-South and non-West states.  The effect is weakest in the western states (as defined by the Census) and strongest in the Northern states.    Segregation is measured using the standard units of Census Tracts within Metropolitan Statistical Areas (as defined by the Census).  The numbers here are the simple averages, across individuals, in each state.   The Dissimilarity Index, used to measure segregation, represents the proportion of a group, in this case African-Americans, that would have to move in a given area to achieve an even racial balance.   So, a Dissimilarity Index of .8, for example, means that 80% of African-Americans would have to move to achieve a racial balance.

Presidents often shape their legacy in responding to crises. The truth is that Presidents in normal situations don't have great latitude to make major changes since power is shared with Congress and other institutions and policy-making involves delays, compromises and limits.

 

In a crisis, however, executive leadership is critical. Usually we cannot tell much about candidates in this respect during campaigns, which are highly scripted processes of communicating endlessly repeated central themes of broad general appeal, like "The Change We Need." This year, however, we have had the most frightening world financial crisis that the great majority of Americans have ever experienced and it was necessary for government to act very strongly and quickly, so both men who may have to implement the solutions had to react.

 

I think that there are some real insights into a possible Obama presidency from observing his responses. He is calm and confident. He seeks the best expert advice. He does not pretend he has answers when he does not. He is not panicked into playing the 24-hour news cycle for short term political gains. He does not wobble around after announcing his stand and he tries to convey relatively clear and consistent messages to the public.

 

Other lessons from both this crisis and his management of the campaign - he tends to have a long-term strategic sense and to manage a coherent and well-run operation and he tends to be moderate, pragmatic, and careful in his approach. In many ways this suggests that an Obama presidency would be radically different than what we've seen in recent history.

 

Another lesson might be drawn from his clear recognition and respect for Congressional leaders and their collaboration with him, something that was not very evident in the early parts of the Carter and Clinton presidencies and wholly lacking now in Washington.

If you want to get really hammered during your debate drinking game, then watch the pre-and-post debate coverage and ad "game-changer" to the list of words. With Election Day rapidly approaching, and Obama's lead looking increasingly insurmountable with each new poll, the punditry is looking at tonight's debate as perhaps McCain's last chance to change the dynamics of the horse race.

 

I don't think there is anything that McCain can do tonight, though, to score this elusive game-changer. Sure Obama could have a major gaffe, but my guess is that whatever McCain says to try to shake things up will fall on deaf ears. Judging from both Obama's large wins in the prior post debate polls and CNN's repugnant real-time dial tester that often goes flat when McCain speaks, America seems to be tuning out John McCain.

 

There are lots of good reasons why his campaign message isn't resonating. Most important among them is that he doesn't appear to have an organizing campaign message. Instead, he's employing a kitchen sink strategy to try to overcome the horrific hand he has been dealt by a political party in disrepair.

 

For all of the legitimate reasons to tune out McCain I can't help but wonder how much of it has to do with his age. Way back in March 2007, for instance, a Gallup Poll revealed that only 42 percent of Americans were completely comfortable voting for a 72 year old, compared to 84 and 77 percent for black and female presidential candidates respectively. Moreover, Simon Jackman (Stanford University) estimates that upwards of 40 percent of Obama backers cite age as a reason for not supporting Senator McCain.

 

This idea of voters taking McCain's age into account strikes me as unreasonably antiquated. After all, seventy is the new fifty. Yet it also strikes me as entirely plausible that a sizable proportion of the population discounts what McCain has to say because they view him as too old to have the fresh ideas needed to get out of its current rut.

 

So assuming the focus group lines again go flat on McCain's words tonight, will his inability to connect merely be the result of championing discredited Republican governing ideals? Or is it also a case of us simply tuning out grandpa?

Those of us that study race in politics believe that race is always an issue in presidential elections. It just so happens that this year, with an African-American candidate, everyone is suddenly taking notice. Unfortunately, for a topic as complicated and sensitive as race, much of the discussion by pundits is simply uniformed and often wrong. As scholars, we are usually do not work in real time: our contributions usually come after the fact, when the news cycle has already had its say. And, even those of us that study race and politics have never experienced an African-American Presidential nominee, so we have little experience on which to draw inference. Nevertheless, this issue it so important, as scholars we should to our best to contribute meaningfully to the debate.

 

On Thursday and Friday of this past week, at UCLA, the Political Science Department sponsored a conference on race and the 2008 election. Rather than the uniformed speculation and partisan slants that dominate the media discussions of race, this conference offered a careful and informed discussion. Most importantly, the talks were supported by facts.

 

An important take-away is that it is absolutely clear that racial attitudes affect some voters' opinions about candidates and thus, affects their vote choice. How big is the effect? Can it change the outcome of this election? This is more difficult to ascertain. It seems clear, however, that the recently announced estimate, from the AP\Yahoo poll, that Barack Obama's race would cost him 6 percentage points of the vote was inaccurate and probably overestimated.

 

I can offer a few predictions about the state of knowledge on this subject. One is that it is not clear how much this election will teach us about future elections and other, potential minority candidates. Obama might be too extraordinary of a candidate. It also may be that the extraordinary economic circumstances just make this election too unusual to be much good for the purposes of building models for the future. However, it also seems that once this election is done, scholars will have very rich data which will be used to retrospectively analyze the election. Scholars know that this election is unusual and they are very carefully tailoring their surveys and other research instruments. This careful selection and calibration of instruments makes it much more likely that, after the election, scholars will be able to detect any effect that race may have had on the outcome.