I am in Chicago today talking to education reporters about what might help urban teachers to meet the enormous challenges placed before them-- 50% and higher drop out rates, single digit percentages of students actually meeting test standards, whole city school systems on the verge of going into receivership (taken over by the state). Given that huge percentages of our students in the US are attending these schools, I wonder why this has not been a bigger issue on the campaign trail. I understand that we appear to be in an economic meltdown and bread and butter issues are always the most important to voters. It has even taken over almost all discussion of the Iraq war where we continue to lose soldiers daily and where the nation's treasury is being invested. (Even the massive buy outs of AIG and others pale by comparison to the money we have dumped in Iraq.) But, when this economic crisis passes, who will work in this economy? Who will be able to get jobs? What will we do about the millions of young people who are unable to get a job--or create one-- because they are so woefully undereducated?

 

Sometimes in the academy our focus gets narrowed to the kids whom we see in our classrooms --the winners in the education lottery. But the reality is that most American kids don't go to college or get a degree, and proportionally fewer are getting a high school diploma than 20 years ago. If you are black or brown and go to school in the innercity your chances of getting a diploma are often worse than 50-50; chance of getting a college degree are miniscule. In fact, in the last few years we have slipped from number one in college completion to about number 16 internationally. And as our school age population is increasingly poor, innercity, and minority, those figures continue to slip backwards. Mexico was doing a better job of getting degrees to those who went to college. People can debate these rankings, but there is absolute consensus internationally --the US is no longer the world leader in either K-12 OR higher education.

 

I, too, wonder why there isn't more discussion of a key presidential qualification being how "smart" that individual is. But, knowing what I do about IQ testing, I worry much more about how "educated" that person is. And I worry a lot about how educated the voters are --and will be--who will be casting the votes. If you haven't been given a decent high school education are you going to worry a lot about the Ivy League education of your president? I suspect you are going to worry about the chances your child has, growing up in impoverished schools, and looking at a dead end future like your own. Why aren't the campaigns talking more about this? (I don't think that a few lines about getting more charter schools constitutes a conversation.) While McCain may not really know this issue, Obama KNOWS this is a huge issue-- maybe the biggest facing the nation--but even he isn't really talking about it. Why not? And if it is because the analysis is that it isn't a vote getter in this election, why is it that those of us who consider education to be the lifeblood of society aren't making it an issue?

Last time I wrote about whether the most powerful person in the world should also be smart. This seems to have struck a chord with a number of people. I claimed that when considering presidential job applications, an Ivy League degree might be a good thing to look for. Matthew Atkinson, my colleague at UCLA took this a step further and analyzed Presidential IQ and success. He sent me this diagram.

 

 

This plots Presidential IQ against Presidential success. First let me talk about what we see here and then I'll give my two cents on what to make of it.

 

IQ is on the horizontal access and Presidential success is on the vertical axis. You can see that as IQ increases, Presidential success generally increases too. The Presidents for which there is consensus about their IQ are marked in red.

 

You may be thinking that it doesn't really look like much of a pattern - it is true that the relationship is far from perfect. Look at Andrew Jackson, for example: not on the high end of Presidential IQ, but among the most successful. In social sciences, we very rarely find relationships that are very exact. Political science is not physics. We cannot predict Presidential behavior like we can the behavior of an atom. The reason that the Presidents appear all over the plot is that, obviouisly, things other than IQ determine their succes. But you can see a general pattern here. It is clear that, generally, as IQ increases, so does success. In fact, Matthew has labeled the plot to show that, in cases where there is consensus about the IQ of Presidents, the correlation is quite high: .59.

 

Making this particularly fun is that he has plotted John McCain and Barack Obama. This shows how we would expect them to do, based on IQ alone. Time magazine claims to know McCain's IQ to be 133, based on old Navy records. That means that if McCain's success were to be predicted only by IQ, he would be very much in the middle, near some rather undistinguished company, by Presidential standards, like Chester A. Arthur, Rutherford B. Hayes, and George H.W. Bush.

 

What does this mean for Obama? Nobody knows because we don't know his IQ. Matthew has plotted him at three different levels. I'm sure some of you are convinced of his genius - you probably think that a 148 is far too low. However, if we put him there, it predicts he will be as successful as Presidents like John F. Kennedy, John Adams, and James Madison. But he just might not be that smart - we just don't know. Maybe you believe that Obama is closer to McCain, or even below him. These possibilities are plotted in the diagram too. We really just don't know.

 

There are some things we might want to consider when discussing whether big brains make for good Presidents.

 

Most obviously is that we really do not have an adequate measure of Presidential IQ. Matthew gathered his IQ scores from the work of the UC Davis pyschologist Dean Keith Simonton. Simonton, of course, never gave an IQ test to any President. In fact, in being based on old Navy records, McCain's score might be the most accurate score that we have. For all other President's, Simonton scored IQ by combining the work of scholars that have studied Presidential biography. That the scores are based on presidential biography gives me pause because it might be that biographers think that Presidents have high IQ's because they were successful in office. For example, do we think FDR was smart because he was a successful President or was he a successful President because he was smart? It is probably a little of both, which means that the causal relationship between intelligence and Presidential success might be overstated. If IQ measures innate intelligence, being President cannot cause a President to have a higher IQ, it can merely change our perception of their IQ, which in turn makes their success look more related to IQ.

 

It is also worth mentioning that IQ, like many measures of aptitude, is not without its limitations and one should be cautious in trying to predict individual success with such a measure. However, Matthew put it this way:

 

 

Matthew also looked at the relationship between IQ and Presidential success while statistically controlling for previous experience. The result...IQ has a strong relationship with success. Previous experience does not appear to have any observable relationship with success.

 

I should also add, and this is the realm of pure speculation, that maybe the relationship between IQ and Presidential potential is curve-linear, meaning that maybe, if a person gets too smart, it begins to hurt their Presidential capabilities. Think about the smartest person you know - perhaps a college professor - would you really want that person to be President?

In politics, timing may not be everything, but it's certainly important. Nowhere has that been more evident in this election cycle than in the timing of Vice Presidential candidates. We found out that Barack Obama had picked Joe Biden as his running mate on August 22nd-only three days before the start of the Democratic National Convention. Similarly, John McCain announced his pick of Sarah Palin on August 29th-again, only three days before the planned start of the Republican National Convention.

 

In contrast, other recent VP picks were announced earlier in the campaign cycle, and further from each party's nominating conventions. In 2004, John Kerry announced John Edwards as his pick on July 6, 20 days before the start of the DNC. In 2000, George W. Bush picked Dick Cheney on July 25 (6 days before the RNC), while Al Gore picked Joe Lieberman on August 7th (7 days before the DNC). Why were the 2008 vice presidents waiting so long offstage?

 

The answer appears to be a calculation on the part of each campaign to avoid having their messages "stepped on"-or, in the case of McCain, a desire to step on the message of the opposing campaign. Stepping on a message occurs when a politician's desired message or theme is overwhelmed when the news media choose to focus on some other, more interesting story (often provided by the opposing campaign). In some cases, an error or uncoordinated communication by a campaign can result in their "stepping on their own message", i.e.-sapping news coverage of their desired issue in favor of one that is off-topic or distracting.

 

In 2008, the Obama campaign likely delayed their announcement of Biden as their vice presidential choice because of the overwhelming distraction of the 2008 Summer Olympics. The McCain choice, on the other hand, appears to have been timed precisely to stomp on the coverage that would otherwise have been devoted to covering the reaction to Obama's speech to the Democratic National Convention, which had occurred the night before the announcement.

 

Did these efforts work? To get a sense of the effectiveness of each party's efforts, I searched the UCLA Communication Studies Archive's index of news and public affairs programming for each candidate's last name (note that this rough search undoubtedly resulted in a number of false positives from other people sharing the candidates' last names, or from mentions of spouses or relatives). The first chart below looks at the proportion of news and public affairs shows that mentioned each of the candidates, while the second chart simply counts the daily total mentions of that candidate's name across all such shows.

 

The proportion chart shows that until his pick of Sarah Palin as his running mate, John McCain was being mentioned on fewer total programs than the combination of Obama and Biden. Interestingly, Biden appears to have been capturing media attention even before his official nomination, probably due to (correct) media speculation that he would get the nod. In contrast, Palin received almost no attention prior to her selection, and then helped the Republican ticket almost immediately seize attention away from the Democratic ticket (mostly at the expense of Biden, it appears).

 

Looking at the raw count of candidate mentions (which are likely a better measure of overall attention, but reflects the ebb-and-flow of the news week, including relatively less news on the weekend), one can see a similar, but more nuanced story.

 

After the Olympic closing ceremony on August 24th, coverage of the Democratic ticket exploded, peaking at nearly 4,000 combined Obama/Biden mentions the day before Obama's acceptance speech. Despite Hurricane Gustav, it is clear that Palin's pick immediately shifted the media's emphasis to the Republican side, with 3,000 combined mentions of McCain and Palin on the day of her announcement (more than twice as many as Obama and Biden received the day after Obama's big speech). Since then, the Republicans have held a consistent edge in daily mentions, even after the end of the national convention. Interestingly, while Palin was the target of many of these mentions, McCain mentions also exploded, keeping pace or exceeding Palin on most subsequent days.

 

Of course, it must be noted that this analysis does not account for whether the mentions of each candidate were positive or negative, nor is it by any means clear that future coverage will reflect these same patterns. It is clear, however, that the addition of Sarah Palin to the Republican ticket has resulted in far more media attention being directed toward the Republicans at the expense of Democrats.

The candidates are starting to talk about the economy again. Thank you very much! I was starting to wonder if I might have to start writing about the psychology of lying and the therapeutic benefits of lipstick.

 

The big news is the collapse of three large companies - two investment firms and one very large insurer, AIG. As I write this, the Federal government is in the process of bailing AIG out. When insurers lose money (and here we're talking boatloads of cash), they find a way to raise money from their customers through higher premiums and reduced payouts.

 

Today's insurance company is not your father's insurance company. Since Congress passed the Financial Services Modernization Act of 1999, insurance companies have been able to get into the investment business - they get to play the stock market with the other big boys. Instead of the stodgy business of insuring, our insurance companies get to throw the dice along with the rest of Wall Street. They'll even pass on the profits to their policy holders, if claims are low and profits are high. The problem arises when there are losses. Since 1999, we've now experienced not one, but two stock market busts.

 

After the Dot-Com bust, insurance companies raised rates wherever they could. In states where there are minimal regulatory mechanisms, malpractice rates doubled and tripled over a very short period of time (in the absence of increased lawsuits or large payouts). The impact is chilling - physicians move out of these states or simply stop practicing medicine altogether. In Nevada, orthopedic surgeons refused to be on call for Las Vegas' emergency rooms because of these liability issues. Here in California, we have both a cap on jury awards and an insurance commissioner to review insurance rate changes, so some of these effects are blunted. But across the nation, the potential for significant rate increases may have a chilling effect on the practice of medicine. Patients do not need another reason for their doctors to be unavailable.

 

- Michael Eric Dyson, "Is Bill Cosby Right?"

 

I didn't think I'd ever find myself advocating for someone to adopt Bill Cosby's oftentimes spiteful rhetoric emphasizing black personal responsibility over structural forces for the persistence of racial inequality. Yet, if I were David Axelrod my advice to Barack Obama would be to go Cosby immediately. The Obama Campaign seemed hip to this idea early in the summer but has not pursued the black responsibility angle to the extent I thought they would.

 

Here's why it matters. When the media says Barack Obama has a hard time connecting with blue-collar white voters, what they really mean is that he (not surprisingly) has a hard time winning over racially resentful whites. By racially resentful, I am referring here to a concept emanating out of the symbolic racism research of David Sears and Donald Kinder positing that such symbolic racism or racial resentment is characterized by "a blend of anti-black affect and the kind of traditional American moral values embodied in the Protestant Ethic... a form of resistance to change in the racial status quo based on moral feelings that blacks violate such traditional American values as individualism and self-reliance, the work ethic, obedience and discipline"

 

The earliest results from the current campaign show that there is an extraordinary negative effect of this belief system on Obama evaluations. Based on the evidence, then, it certainly appears that racial resentment is the most important reason why Obama can't connect with the white working class even when economic conditions strongly favor the Democratic candidate. As such, an Obama win may very well require deactivating racial resentment.

 

Here's where Cosby comes in. All else being equal, racially resentful whites are actually significantly more favorable towards black Republicans Clarence Thomas, Condi Rice, and Colin Powell than white racial liberals. My guess is that symbolic racists like black Republicans because they serve as an ostensible example that blacks could be just as well off as whites if they only tried harder while simultaneously supporting color-blind policies that do not give African-Americans any "special favors." As is evidenced by their embrace of Bill Cosby's statements, white America loves when black leaders point the finger at such personal attributes for racial inequality. For, not only does it give whites cover to say what they really believe without fear of being called a racist, but it puts the onus on the individual rather than society for remediation.

 

I'm sure the Obama Campaign does not want to push a Cosby-like position. As distasteful as this strategy may be, however, a strong and persistent message emphasizing the need for African-Americans to more forcefully embrace the American values of individualism, self-reliance, obedience and discipline-values which symbolic racists think the black community lacks-is probably Obama's best play at reducing the impact of racial resentment on voter choice in November.

There's been a running joke in my family for years that the real Bush Doctrine is not preemptive/preventive force, as it's popularly defined. Nor certainly is it his "worldview," as Sarah Palin mistakenly answered to Charlie Gibson. The real Bush Doctrine is lowered expectations.

 

In 2000, the Bush Campaign mastered the expectations game. Indeed, our expectations of Bush's debating skills and world knowledge were so successfully lowered that he managed to win the debates against Gore while losing on points. Part of this was Gore's unattractive presentations style (recall the sighs and invasion of Bush's space), but Bush also benefited from his assiduous promotion of Gore's reputation as a strong debating policy wonk. The fact that the affable neophyte was not eaten by the big bad wonk was itself a victory for Bush. The 2004 Bush Campaign tried to repeat this strategy, even playing up John Kerry's pedigree on the Yale debate team.

 

The White House has also learned from their violations of the Bush Doctrine of lowered expectations in the foreign policy realm. After raising the country's expectations that we'd get bin Laden "dead or alive" and that we'd be greeted as liberators in Iraq, they've changed the goal posts just a bit. The expectations are in fact now so low in Iraq that success is touted by the mere prospect of a quasi stable county. The Bush Doctrine of lowered expectations at its finest.

 

It's ironic, then, that Sarah Palin has come under some criticism for not knowing what the Bush Doctrine is. For, if the real Bush Doctrine is lowered expectations, she seems to get it perfectly. You'd think that a vice presidential candidate not knowing about America's biggest foreign policy shift since the Truman Doctrine (that was containment on the slim chance Sarah Palin is reading and needs the definition) might be a bigger cause for concern. Not so, though, when our expectations are so low of her that proximity to Russia and her initiative in sucking oil from a petro rich state are said to be foreign policy qualifications.

 

Poor Joe Biden; he doesn't stand a chance in the upcoming debate. All Palin has to do is repeat the talking points robotically crammed into her head like "Israel is our friend and we won't second guess her" and she'll win. After all, we don't really expect the affable neophyte to be able to match the big bad wonk on points do we?

 

Ah, the Palin Doctrine at its finest.

With all the talk of experience in the presidential campaign, there's one glaring omission: experience in the shadowy world of intelligence. Both Barack Obama and John McCain are senators. Both have served on important national security committees. But neither candidate has any serious experience dealing with intelligence agencies from inside the executive branch.

 

Some say it doesn't matter. Congressional experience gives the candidates enough familiarity with how intelligence agencies operate and how the intelligence process works. Kennedy, Reagan, and Clinton were all intelligence neophytes, all governors before they were elected president.

 

Maybe that's right. But consider this:

 

1. Working with intel agencies from Congress isn't anything close to working with them from the White House. It's kind of like the difference between watching/funding/complaining about open heart surgery versus running the medical teams that perform open heart surgery.

 

2. Intel producers and customers are from radically different tribes. Intel people are all about data and analysis. Policymakers are all about action. Intel people use caveats and nuance. Policymakers tend to gloss over them. Intel people try to focus on strategic intelligence, the longer, over-the-horizon thinking. Policy people want to know what to do about North Korea this afternoon. Intel people live in a world where things get done by writing on paper. Policymakers live in a world where things get done by working with people. Even words mean different things. What's a "fair chance of success?" What does "moderately confident" mean? An effective foreign policy requires a White House that understands the foreign culture known as intelligence.

 

3. There's an old joke in the CIA that Director William Casey wouldn't tell you if your coat was on fire unless you asked him. To effectively run the Intelligence Community, policymakers need to know what questions to ask, where to push, where to probe, where and how to ask for help. That's harder to do if you haven't done it before.

 

4. In the post-9/11 world, intelligence is more important and less understood than ever. As CIA Director Michael Hayden once noted, during the Cold War the Soviet enemy was easy to find but hard to kill. Massive military power was critical. Today, terrorists are easy to kill but hard to find. Intelligence, not sheer firepower, is the key to keeping Americans safe.

 

On-the-job learning may not be that difficult. But understanding how to manage our $40 billion intelligence apparatus will be one more thing on the president-elect's long and ever-growing to-do list.

There is supposedly a tension between the President you'd rather drink a beer with or President who is smarter than you. Which would make a better President? This is something we can actually leverage science to test.

 

Pundits are saying that the ''Culture War'' is in full swing again this election. This is nothing new. At least part of the "culture war", the part that associates liberalism with intellectualism and snobbery, is simply a new manifestation of the anti-elitism that dates, in Presidential politics, to at least Andrew Jackson and probably as far back as Thomas Jefferson. In a country as large and diverse as the United States, a certain form of this might be inevitable, but the degree to which anti-elitism operates is, to my knowledge, particularly American.

 

Conservatives practice overt anti-elitism that can be mixed with a type of subtle racism in a way that, I imagine, is also uniquely American. Of course, liberals practice their own opposition politics, in the form of a more covert snobbery. Despite protestations, and that what he was saying may have been accurate, in describing certain Americans as "bitter" and "clinging", Barack Obama was using a form of snobbery what many on the left articulate regularly without realizing it. It is the anti-guy you'd like to have a beer with politics. Reading liberal blogs and columns, there is an unstated understanding that Sarah Palin's moose-hunting is something that a certain type of person doesn't do: the persons you want to be President. To many liberals, persons like them don't hunt moose.

 

In an earlier blog entry, Michael Tesler touched on aspects of this current of American politics. Michael raised what is a legitimate question about electoral preference, that is why shouldn't we care about educational attainment and, what he called, "innate intelligence". He believes that we should care. Michael's question becomes especially meaningful in the context of U.S. elections because concerns about education and intelligence are associated with anti-elitism and its liberal equivalent. There is no doubt that anti-elitism has electoral currency. And it raises concerns if anti-elitism can be leveraged to bring victory at the expense of qualities we want in leaders: educational attainment and innate intelligence. We assume these qualities are associated with capability as a leader.

 

From the perspective of political science, this is an empirical question. Does it make a difference if smart people are in the White House. To test this, we need to measure whether Presidents are smart and whether they were successful as President.

 

We don't have a good measure of intelligence for nearly anyone, let alone public figures, so seeing if Presidential capability is associated with intelligence is fruitless. However, it is probably true that intelligence is partially reflected in educational attainment. Certainly this is part of the implication in the comparison of Palin's University of Idaho B.A. to Obama's Harvard J.D.. Of course, outside of the privileged circles from which most of our politicians come, there are many institutional detriments to the innately intelligent attending the elite universities. I'm willing to bet that Alaskans are under-represented in the Ivy League. Nevertheless, innate intelligence probably can be predicted, albeit imperfectly, by educational attainment.

 

However Presidents, are an example of people for which educational attainment might not be a good predictor of intelligence or capability. The economist Alan Krueger demonstrated that the career success differential between Ivy League graduates and graduates of other institutions is greatly diminished when controlling for other factors that contribute to success, like hard work. The idea being that most people that go to Ivy League schools are hard workers, so it is hard work that is driving their success, not the Ivy League. Equally hard workers that go to other universities are also successful. It is probably safe to say that most people that become President of the United States are hard workers and talented (protestations to the contrary aside), so this might be a good example of Krueger's finding.

 

Using anecdote, we can see how the Ivy League might not be a good predictor of Presidential success: there are quite a few Presidents that graduated from what might, generously, be called obscure educational institutions: most recently Lyndon B. Johnson from Southwest Texas State Teachers College and Ronald Reagan from Eureka College (in Illinois). And there was even a bunch that didn't go to college at all. Not going to college was more of a Nineteenth Century phenomenon, however, more recently Harry Truman achieved the highest office in the land having not obtained a degree. I also might add that Truman had a lack of experience, when he became Vice President, that would rival that of both Barack Obama and Sarah Palin.

 

Fortunately though, we don't have to rely on anecdote. The beauty of science is that we can attempt to leverage measurement to answer these questions. Of course, measurement is not without problems. I will not even attempt to enter the problematic world of measuring the quality of universities, instead I will just note if a President's alma matter is Ivy League or not. I will, though, attempt to enter the problematic world of measuring the quality of Presidents.

 

In surveys, historians and regular people tend to consistently rank some presidents the best and some the worst. There are many more that are relegated to obscurity and, as such, ranked in the middle of the pack. I believe that, more than anything, these rankings reflect capability. There were those that proved capable to handle their responsibility and those that did not. Those relegated to obscurity seem to be those that had the misfortune of leading during times of relative peace and calm - which may be an accomplishment in itself. However peace and calm precludes fewer Presidents since the turn of the 20th Century as the United States has seldom enjoyed eithersustained peace or calm. In the court of public and expert opinion, those that lead during tumultuous times seem to clearly be divided into those that we capable during the tumult and those were not. You know who they are. Capable, names like Washington, Lincoln, Roosevelt; incapable, names like Buchannan and Hoover. Of course, there were Presidents that did not preside during a tumultuous time and managed to undo their legacy anyway, names like Grant and Harding.

 

There are a variety of rankings of Presidents and they all have idiosyncracies. The way to best capture the consensus of these rankings is to take their average. In general, taking the average of different rankings tends to reduce the influence of idiosyncracies of any particular ranking. This type of averaging, a form of the 'wisdom of crowds' often proves remarkably capable of finding measurements close to the truth. Of course, there is no objective truth in these rankings, only opinions, so by averaging, I am merely reducing the leverage of inconsistent rankings.

 

If we examine the educational attainment of Presidents in relation to the ranking of Presidents a pattern does emerge. Presidents that attended Ivy League universities are, on average, far more highly ranked than Presidents overall. Even when controlling for other factors, like graduate degrees and century in which they were President, having attended an Ivy League school has a large effect on the perceived capability of Presidents and the effect is statistically significant (meaning the relationship is unlikely to have happened by chance). In fact, Presidents that either did not attend college or went to obscure colleges do worse than the average President.

 

How much does having an Ivy League degree matter? On average, a President with an Ivy League education scores about 8 points better than a President with no Ivy League degree. That is the equivalent of moving from James K. Polk to Franklin Roosevelt, or James Monroe to Theodore Roosevelt, or Dwight Eisenhower to Abraham Lincoln.

 

If you're curious: the Roosevelts both went to Harvard. Polk to the University of North Carolina, Chapel Hill. Monroe to William and Mary (which graduated more Presidents than anywhere next to Harvard and Yale). Eisenhower, of course, graduated from West Point. Lincoln didn't go to college.

 

Does this mean that being from the Ivy League causes you to be a good President? No, not in the least. However, it does indicate that Michael might be right in that educational attainment is something we should consider when choosing our Presidents. Educational attaintment, in the form of an Ivy League degree, seems to be a pretty good predictor of how a President is going to perform. Or, at least, it is a good predictor of how history will judge him. And, in voting, isn't predicting what we are trying to do?

 

Of course, Bush is an Ivy Leaguer and, apparently, also somebody many of us would like to share a beer with.

 

(One note on this, I was pleased to see that when I coded Stanford University as an Ivy League, which I imagine many in Palo Alto consider themselves to be equal to or greater, this relationship between Ivy League education and Presidential capability became much more murky. It failed to achieve the commonly accepted standards of statistical significance. However, I do have to admit that this probably more of a reflection of the fact that the lone Stanford alumni to become President was Herbert Hoover. In statistical measurement, is usually considered bad to let one case have to much leverage. So despite the fact that I would love to see Stanford prove that good schools don't make good Presidents, I think it is safe to consider this case as an outlier. It should be notedthat when Hoover attended Stanford in the late 19th century, it hardly had the prominence of today, so there is good reason not to code it as Ivy League. Public universities also do very well, until you eliminate the College of William and Mary (yes, that is a public university).)

Do our politicians understand in a fundamental way what their policy decisions mean for the rank and file of our nation, and if they do, how do they behave? Empathy is a powerful emotion. We depend upon it to make important decisions in our day-to-day interactions with others. It is almost automatic to say, "I know how you feel." It is probably one of the great assets for a politician to know how to connect to others in this visceral way. Bill Clinton is a contemporary politician well known for his ability to connect. George H.W. Bush was famous for his stiffness.

 

As a physician, my ability to listen to a patient and to understand what they are feeling occurs at several levels. As I have gotten older, though, my understanding and the conviction behind "I know how you feel" has strengthened because truly, I have begun to experience many of the ills that my patients tell me about. I know in a first hand way about sprained ankles and carpal tunnel syndrome, about relatives with severe illnesses, and friends dying young from illness and from violence. So, I have become better informed and perhaps a better physician.

 

In my last blog entry, I introduced some stark facts regarding healthcare coverage in the United States. Can any of our politicians understand what it means to be without healthcare insurance or the benefits that they derive? Three senators and one governor - all have excellent health coverage for themselves and their loved ones. They have benefited from being employed and being elected (even better). Based upon my understanding, I wanted to make examples of how these four politicians know or benefit from the healthcare system and their health insurance.

 

John McCain has had federally funded healthcare for his entire life (including veterans benefits for service-related injuries). He needs that continuous coverage and the guarantee of Medicare (for persons 65 years old and older) because if he were a normal Joe with four episodes of melanoma, he would either be excluded as being too high risk or be paying out-of-pocket for surveillance healthcare for this condition.

 

Barack Obama knows about health. He has smoked cigarettes in the past. This might be an exclusion for life insurance or even higher premiums on health insurance. His mother died of ovarian cancer in her early fifties. There are over twenty thousand new cases and fifteen thousand deaths attributable to this disease in the U.S. every year. Most cases are sporadic, but perhaps up to 10% have an identifiable genetic component. If he is a carrier of the BRCA1 or BRCA2 gene, his children may have this gene as well and be at risk. As they get older, their doctor and they may decide to evaluate this risk. Fortunately, it is covered. If they know that they have it, will anyone be willing to insure them?

 

Sarah Palin has a baby with special needs, who with luck will live a long and healthy life. However, a baby with Down Syndrome is not just developmentally delayed, it has a very high risk for congenital and chronic healthcare problems. Fortunately for Governor Palin, her baby is eligible for Medicaid and other publicly funded services that will ensure that her baby gets the care that it needs, because we all contribute to that public good. With luck, her baby will outlive her and become the responsibility of her other children and of Society. Governor Palin's unemployed, unmarried pregnant oldest daughter (and unborn baby) who may no longer be eligible for the Governor's healthcare insurance once she gets married, will be eligible for Medicaid through the WIC (Women, Infants, and Children) Program.

 

Joe Biden lost his first wife and two children in a car accident. His two other children from that marriage were critically injured in the accident, but survived. He later nearly died from a brain aneurism. He must appreciate the value of having emergency rooms and emergency trauma services. In a country with so many uninsured, a crisis is brewing as emergency rooms and trauma centers close. The hospital emergency department is where the hospital meets the street curb, and by law, they cannot turn people away, regardless of ability to pay. The only way for a hospital to prevent losses through the emergency department (because their patients are uninsured) is to not have an emergency department.

 

As we look at the healthcare proposals and attitudes of the parties and their candidates, let's ask whether their proposals reflect their experiences or hypothetical situations for which we must depend upon their empathy.