The vicious punch that sent boxer straight into retirement

Bare-knuckle boxing proved its brutality with a horrific knockout on Saturday night. Johnavan Vistante was on the receiving end of a savage right-hook that left him sprawled out on the canvas. Following a dominant first round, Kaleb Harris landed the cruel blow nearly a minute into the second. Vistante went for the uppercut but left...
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Telemedicine Has Resurrected the House Call
In the 1880s, a few short years after the telephone’s invention, futurists envisioned a modern doctor unrestricted by time and space. “That specialist would sit in a web of wires,” the Johns Hopkins medical historian Jeremy Greene told me, “and take the pulse of the nation.” At the time, and for decades after, medical practice remained circumscribed by geography. Black bag in tow, packed with every tool a physician would need, roaming doctors travelled by automobile or horseback and tended to the bedridden wherever they lay. But by the mid-20th century, clinicians stopped trekking from household to household.“The old-school home visit is just totally impractical,” Charles Owens, the director of Georgia Southern University’s Center for Public Health Practice and Research, told me. “It’s logistically kind of a train wreck.” Cars, public transportation, and sprawling hospital systems eventually converted home visits from a standard of care—40 percent of physician encounters in 1930—to a relic, just 1 percent by 1980. Patients, then and now, flocked to doctor’s offices.Today, telehealth has resurrected the house call more than a century after it fell out of favor. This newfangled iteration of a bygone practice is less intimate than having a doctor sitting at your bedside, but more personal than sitting on your doctor’s exam table. For some people, virtual home visits are about as uncomfortable as being poked and prodded in a hospital gown, but they allow doctors to once again observe quotidian details of their patients’ health that they might not otherwise glimpse. “The doctor’s office is a stressful place for everyone,” Mark Fendrick, a primary-care doctor with Michigan Medicine, told me. “There are some things we look for that are more artificial in a doctor’s office and more real-world at home.”[Read: The doctor that never sleeps]Studies have shown, for example, that automated blood-pressure measurements taken when a patient is sitting alone in a quiet place are more accurate. People with white-coat hypertension regularly experience higher blood pressure in clinical settings as a result of anxiety or fear. At-home tests, Fendrick said, can better capture a person’s usual blood pressure.Along the same lines, some patients seem to perform better on telehealth cognitive tests for dementia, Julia Loewenthal, a geriatrician at Boston’s Brigham and Women’s Hospital, told me. In-office exams can be exhausting, nerve-racking ordeals that sap memory and attention; at home, patients are more relaxed and clearer-minded. “It reduces test anxiety,” Loewenthal said.A virtual house call can also improve the quality of treatments. Christina Dierkes, a 37-year-old from Columbus, Ohio, usually dreads the end of an intense therapy session. “You bare your soul to this person,” she told me, “and then you’re running into somebody in the elevator and sitting in the car crying and driving home.” Since March, she’s connected with her therapist over the phone, from safe within her pandemic cocoon. “I was at home, in my own space, in sweatpants. It made it easier to imagine I was talking to myself or someone I feel really safe with,” she said.This advantage is, to some degree, subjective. David Bober, a 51-year-old in Maryland, struggles to find a quiet spot at home where he won’t be overheard or interrupted during psychiatry sessions and is ready to return to in-person therapy. “I’d be happy to sit 12 feet away, on the other side of the room, wearing a mask,” he says. And having to verbalize bodily concerns to a doctor who can’t touch or examine a patient up close can be a source of discomfort. Jon Johns, a 54-year-old in eastern Ohio, had his annual physical—it went well—over videoconference in April. “But what if I was in pain or something was wrong?” he says. “I would be anxious about how well I was describing my symptoms.”Read: You can buy prescription drugs without seeing a doctorWhatever might be missing from the patient’s descriptions, doctors can glean information through telemedicine that they wouldn’t otherwise have access to. And this might be the true magic of the virtual house call.The family doctor Carman Ciervo, for example, can’t check a pulse or administer a vaccine through a screen. But over video, Ciervo, a primary care physician for Jefferson Health, in Philadelphia, goes over the prescriptions in his patients’ medicine cabinet one by one. He gauges nutrition by peeking inside fridges. In summertime, Ciervo asks to see thermostats to make sure they’re on and functional. If a patient has mobility issues, he monitors the video’s background for railings or potential tripping hazards.“Just observing how they climb the stairs can give you a wealth of information,” Ciervo says. “These are all safety problems they might not be aware of, and that might not come up in an office visit.”Susan Kressly, a pediatrician in Pennsylvania, says her patients—who are often fidgety, anxious, and reserved in her office—are relaxed and outgoing when talking with her from their bedrooms. “When you move the playing field to the patient’s home base,” she told me, “some of that power imbalance and discomfort with the setting goes away.”The screen also opens a wider window into each child’s personality, Kressly said. Have they been riding the bike she sees in the background and playing with the dog who keeps running in and out of the frame? What’s on their bookshelf? Do they have a sibling to play with or a fort to hide away in? “All of a sudden, you’ve created a personal connection to them as human beings,” she said. “We get a glimpse inside the reality of where patients spend a lot of time—with COVID, a majority of the time.”[Read: The sexual health supply chain is broken]However, as the Kansas City University medical historian Kirby Randolph points out, keeping one’s personal life private might be the point of going into a generic doctor’s office. “A lot of patients don’t want the doctor to see their home environment, because they’re self-conscious,” she told me. Domesticating medicine’s turf won’t cure the biases baked into its history—racism, classism, homophobia, sexism, sizeism, and ageism among them—that could color how a clinician interprets a patient’s surroundings.During the era of traditional house calls, for example, some white physicians refused to enter Black households or treat Black patients, she said. Today, the rooms revealed on video conference broadcast the pay gap between clinician and client (whose income may be dwarfed by their doctor’s six-figure salary). For racial minorities, rural residents, and the elderly—who more often struggle with lower-quality or nonexistent home internet connections—that socioeconomic disparity might be further amplified by IT issues. Once connected, poorer patients, Randolph said, might worry they’ll be blamed for their health problems if a doctor sees an ashtray or junk food on the coffee table.“The very deep social determinants of health and illness seem so intractable that finding a technological solution that might short-circuit them is enormously appealing,” said Greene, the Johns Hopkins historian. “But technology can be liberating and oppressing.”Modern medicine has embraced the notion that a person’s well-being is shaped by intimate forces such as upbringing, social circles, and access to transportation and fresh groceries. And yet, most doctors are trained to practice in sanitized, corporate environments and not in the home—“exposed to violence or viruses or the awkwardness of standing in somebody’s house,” Randolph said.The virtual house call may seem as revolutionary as the 19th-century vision of a modern physician, nested in wires, taking a patient’s pulse from miles away. It challenges the notion that medicine exists only in clinical settings, and offers doctors a view into the space where a person’s health exists as a lived experience. But even virtual medicine takes place somewhere, and that location still shapes the quality of care, for better or worse, from patient to patient. “The idea of meeting the person where they’re at,” Randolph said, “that’s not a preference for everyone.”
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Why Joe Biden Can’t Make a Plan
Will we have a coronavirus vaccine by Inauguration Day, or will it still be several months off? If we do have a vaccine, will it have been competently distributed, or will America be a haphazard patchwork of immunity? Will the spread of infection, and the deaths that follow, slow or quicken? Will the economy have stabilized, or will the country be careening into the worst hole in human memory?Joe Biden does not know the answers to any of those questions—no one does. But the many uncertainties make it exceptionally hard for the presumptive Democratic nominee to plan what he’d do if he is elected president.“When President Biden is sworn in, in January, who knows how many people will have died by then?” California Representative Karen Bass, a potential vice-presidential candidate, told me. “And then who knows what the economy would be? We could be in a depression.”By August of most presidential-election years, the candidates have offered policy blueprints for the four years ahead. This exercise always has a level of science fiction to it—the ideas are aspirational, based on generous assumptions about what Congress and the voters will actually support. This race is different: Donald Trump has repeatedly whiffed when asked what he’d do in his second term (even though the questions have been gently lobbed at him by friendly Fox News hosts), and the coronavirus has left Biden laying out broad guesses, not knowing how bad public health and the economy will be by the time he’d take over, if he wins.[Read: The advantage of a Biden shadow cabinet]What Biden faces will be familiar, on a smaller scale, to any American trying to plan for the future. Six months ago, few outside of China had ever heard of social distancing or the coronavirus. Six months from now, the situation could have changed multiple times.The result, though, is that Biden is left hoping America elects him on a hunch of what he’d do—because it remains a mystery.Jake Sullivan, the adviser managing coronavirus policy development for Biden, has been helping put together what the campaign calls the “Build Back Better” agenda, which includes general proposals such as investing in manufacturing and small businesses and taking a more structural approach to thinking about racial equity and health care. It hasn’t been easy.“We’re trying to set down road maps and guidelines that work and would be relevant under a range of different scenarios,” Sullivan told me, “with enough specificity that we can show how the vice president would be different from the current incompetent response, but also with enough flexibility to accommodate a number of different realties that may present themselves with respect to what the economic and pandemic situation may be by January.”Biden and his team are more optimistic about the trajectory of the pandemic itself, believing that the infection and death rates will be more under control by January. They’ve seen evidence that real therapeutics are coming soon, and they are holding out hope for a vaccine.[Read: A vaccine reality check]That’s where their hope runs out. Early in the pandemic, Biden’s advisers were having private discussions that looked at a potentially fast, “V-shaped” economic recovery, I’m told. Into the summer, they were eyeing the turnarounds in some European countries, thinking that might be possible here. But with each day, they have gotten more worried about what would await Biden if he wins. “We don’t know exactly what the unemployment number is going to be, or what the economic situation is going to be, but we know it’s not going to be good,” Sullivan told me.Like any other major presidential nominee, Biden already has a transition team in place in the event that he wins. By law, that process needs to begin over the summer, with collaborations among agencies across the federal government, even if that means a lot of wasted effort should Biden lose. Ted Kaufman, Biden’s close friend and former chief of staff, is running the campaign’s transition process. This is the third transition Kaufman has been a part of, and when he served as a senator from Delaware after being appointed to the seat Biden gave up to be elected vice president, he wrote a law strengthening the transition process.This transition is like nothing Kaufman has dealt with before, he told me.Already, Kaufman said he has begun building a bigger team than normal to account for the different scenarios the transition will have to consider. “We have to plan what we call ‘unconventional challenges’ surrounding Trump, COVID-19, and the economy,” he said. “Changing power for the most powerful country in the history of the world is always a challenge. Every four years, it gets exponentially harder, and that’s even truer with today’s unconventional challenges.”Take reopening schools—potentially the pandemic problem that will shape society and the economy the most over the next year. Trump has no plan to reopen schools, other than demanding that they open and claiming that they’re not opening for “political” reasons, rather than because of the health and infrastructure worries that most parents and staff have. “My view is the schools should open. This thing's going away. It will go away like things go away,” Trump said on Wednesday morning in an appearance on Fox News. Biden, meanwhile, has issued a framework that calls to put health first and that proposes a $90 billion fund to help schools make changes. He can’t do anything to implement it. And if he does win, he would be coming into office more than halfway through the school year. Biden’s advisers are tossing around ideas internally, such as potentially proposing once in office that a new school year start date of March 1 or April 1, and then extending it into next summer, but they know that at the moment, this is all just wishful thinking. And that doesn’t even account for the state-by-state negotiations with teachers’ unions that any extension would entail, and that would likely require federal leadership, among all the other elements they’d need to make any of this workable.Or imagine what would happen if promising developments are made on a coronavirus vaccine by the fall. Most expect that Trump would be pushing people to rush to get it, whereas Biden expects to urge careful safety testing first. Aside from the cognitive dissonance of Trump, who has courted anti-vaxxers, being pro-vaccine and Biden hesitating, there will almost certainly be huge problems in production and distribution of a vaccine. The Trump administration has taken no clear steps to prepare, and Biden can only issue statements about how more preparations are needed. Even if a vaccine is ready by Election Day, there’s no way to know how many Americans would be vaccinated by Inauguration Day.[Read: What Biden learned the last time the world stopped]Meanwhile, ideas for how to spark economic growth, even those that Biden has proposed in campaign speeches, are all being trimmed. “If you want to do a big infrastructure bill, how much can you do?” Kaufman said. “I don’t know what there’s going to be when Trump gets through, in terms of our debt as a percent of the gross domestic product. We know it’s not going to be good.”Biden’s approach to the economy is to go big on spending—maybe not at the level of the $4 trillion in stimulus money spent so far, but probably not far behind. Campaign aides are assuming that he would have to pass a big spending bill next year, but cannot tell yet if that money would be more for relief or for recovery planning.Advisers are carefully watching the current negotiations in Congress, anxious that they could create new problems if they result in a deal that expires at the end of January—assuming Congress is able to make a deal at all. There is some logic to that, given that Senate Republicans haven’t approved any new funding since May, and that Congress expects to go on a long recess through the election and might not want to leave such big decisions to a lame-duck session in December. However, that means Biden could be immediately thrown into intense congressional negotiations if he’s elected, likely after a transition made difficult by Trump’s expected lack of cooperation and with other crises looming. Then again, polls suggest that Biden might be coming into office with Democratic majorities in the House and Senate, which would redefine the negotiations to make a deal both more to his liking and easier to finalize.Biden has been in regular contact with House Speaker Nancy Pelosi and Senate Minority Leader Chuck Schumer. Aides who have been told about these conversations say they’re mostly check-ins from Biden, who is leaving the negotiations to congressional leadership. “Having been in a lot of those rooms, the vice president knows you can’t run an operation like this by remote control,” Sullivan told me. In speaking with other aides on the Hill, they describe a sense of relief in not having to worry about getting from Biden what Senate Republicans have been getting from Trump. In March, the Senate GOP waited on an approving tweet from him before voting on the last big relief bill. In the past week, Trump has called the new Senate Republican bill “semi-irrelevant,” and had White House aides push for $1.75 billion to build a new FBI headquarters, to the annoyed surprise of Senate Majority Leader Mitch McConnell.[Peter Beinart: Biden goes big without sounding like it]Local and state governments are also trying to sort out their long-term planning, not knowing what the situation will be, or what will be happening in the federal government.New Jersey Governor Phil Murphy, for example, has already extended his state’s budget for three months over the summer, as he worked to get a handle on the state’s outbreak and a sense of the finances in Trenton. Because Murphy is the only major Democratic leader who’s kept up a good relationship with Trump during the pandemic—even getting an invitation to dinner at the president’s Bedminster golf club in June—I asked Murphy what he might expect from a Biden presidency instead.He answered carefully, trying to preserve his relationship with Trump, and to account for how hard it is to tell what Biden would do.“It’s probably more values based. You’d see consistent mask wearing by him. You’d probably see a pretty significant investment in manufacturing to replenish the strategic stockpile. I suspect a lot of the energies, which are largely private sector, being put into therapeutics and vaccines would be encouraged by his administration and by his folks,” he told me. “There’s no question I’m for Joe Biden for president. But if that were not to come to pass, you just hope, please, God, you’ll get a continually more robust response by the current administration.”
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How inequality is changing the Republican Party — and breaking American politics
President Donald Trump shakes hands in 2017 with then-House Speaker Paul Ryan, as Vice President Mike Pence beams. | Bill Clark-Pool/Getty Images A new book tries to untangle the relationship between white identity politics and skyrocketing inequality. Historically, conservative political parties face the problem Harvard political scientist Daniel Ziblatt calls “the conservative dilemma.” How does a party that represents the interests of moneyed elites win elections in a democracy? The dilemma sharpens as inequality widens: The more the haves have, the more have-nots there are who will vote to tax them. This is not mere ivory-tower theorizing. Conservative politicians know the bind they’re in. When Mitt Romney told a room of donors during the 2012 election that there were “47 percent of the people who will vote for the president no matter what” because they “believe that they are entitled to health care, to food, to housing, to you name it,” even though they “pay no income tax,” he was describing the conservative dilemma. “Our message of low taxes doesn’t connect,” he said, a bit sadly. If anything, Romney understated the case. Sure, 47 percent of Americans, in 2011, didn’t pay federal income taxes — though they paid a variety of other taxes, ranging from federal payroll taxes to state sales taxes. But slicing the electorate by income tax burden only makes sense if you’re wealthy enough for income taxes to be your primary economic irritant. That’s not true for most people. Romney’s 53 percent versus 47 percent split was a gentle rendering of an economy where the rich were siphoning off startling quantities of wealth. Occupy Wall Street’s rallying cry — “We are the 99%!” — framed the math behind the conservative dilemma more directly: How do you keep winning elections and cutting taxes for the rich in a (putative) democracy where the top 1 percent went from 11 percent of national income in 1980 to 20 percent in 2016, and the bottom 50 percent fell from 21 percent of national income in 1980 to 13 percent in 2016? How do you keep your party from being buried by the 99 percent banding together to vote that income share back into their own pockets? In their new book, Let Them Eat Tweets: How the Right Rules in an Age of Extreme Inequality, political scientists Jacob Hacker and Paul Pierson offer three possible answers. You can cease being a party built around tax cuts for the rich and try to develop an economic agenda that will appeal to the middle class. You can try to change the political topic, centering politics on racial, religious, and nationalist grievance. Or you can try to undermine democracy itself. Despite endless calls for the GOP to choose door No. 1 — and poll after poll showing their voting base desperate for leaders who would represent their economic interests while reflecting their cultural grievances — Republican elites have refused. Take the 2018 tax cuts. Donald Trump might have run as a populist prepared to raise taxes on plutocrats like, well, him, but according to an analysis by the nonpartisan Tax Policy Center, the bill he signed gave more than 20 percent of its benefits over the first 10 years, and more than 80 percent of the benefits that last beyond the first 10 years, to the top 1 percent. For that reason, it’s one of the most unpopular bills to ever be signed into law. It’s not the kind of accomplishment you can run for reelection on. From Let Them Eat Tweets, by Jacob Hacker and Paul Pierson That’s left Republicans reliant on the second and third strategies. Hacker and Pierson call the resulting ideology “plutocratic populism,” and their book is sharp and thoughtful on how the GOP got here and the dangers of the path they’ve chosen. Where it’s less convincing is in its description of where “here” is: Does Trump represent the culmination of the Republican coalition or the contradictions that will ultimately tear it apart? The logic, and illogic, of plutocratic populism Plutocratic populism presents as a contradiction — like shouted silence or carnivorous vegan. The key to Hacker and Pierson’s formulation is that, in the GOP, plutocracy and populism operate on different axes. The plutocrats control economic policy, and the populists win elections by deepening racial, religious, and nationalist grievances. “To advance an unpopular plutocratic agenda, Republicans have escalated white backlash — and, increasingly, undermined democracy,” Hacker and Pierson write. “In the United States, then, plutocracy and right-wing populism have not been opposing forces. Instead, they have been locked in a doom loop of escalating extremism that must be disrupted. This is their synthesis of the great economic anxiety versus racial resentment debate. Republican elites weaponize racial resentment to win voters who would otherwise vote their economic self-interest. Hacker and Pierson are careful to sidestep the crude version that holds that ethnic and religious division are mere distractions. Voters see racial and religious dominance as political interests as compelling and legitimate as tax benefits, and the demand for politicians to reflect those underlying resentments and fears is real. David McNew/Getty Images A demonstrator questions the citizenship of President Obama at an American Family Association (AFA)-sponsored T.E.A. (Taxed Enough Already) Party in 2009. Weirdly, their sign says nothing about taxes. This is a key point in Hacker and Pierson’s analysis: They focus on the decisions made by GOP elites, not the desires of conservative voters. Their fundamental claim is that if Republican elites had chosen a more politically sellable economic agenda, they would have — or at least could have — resisted the lure of white resentment and still won elections. But once they made tax cuts for the rich and opposition to universal health care the immovable lodestones of their governance, they had little political choice save to power their movement with the dirty, but abundant, energy offered by ethnonationalism. The most compelling evidence Hacker and Pierson cite for this argument comes from a study conducted by political scientists Margit Tavits and Joshua Potter, which looked at party platforms from 450 parties in 41 countries between 1945 and 2010. Tavits and Potter find that as inequality rises, conservative parties ratchet up their emphasis on religious and racial grievances — particularly in countries with deep racial and religious fractures. The pivot only works, Tavits and Potter say, when there is high “social demand” for ethnonationalist conflict. The question this raises, and which Hacker and Pierson don’t really answer, is what would happen to this demand in the absence of conservative politicians willing to meet it — particularly in an age of weakened political parties, demographic change, and identitarian social media? Trump’s rise, which Hacker and Pierson present as the culmination of plutocratic populism, can also be read as a symptom of its mounting internal contradictions, and of the way Republicans voters are increasingly capable of demanding the representation they want. It may be that the uneasy coalition that married white identitarians to Davos Man is breaking apart. Indeed, reading Hacker and Pierson’s book, I found myself wondering whether inequality was, itself, the cause of the coalition’s collapse: Perhaps the plutocratic agenda is becoming too unpopular to even survive Republican presidential primaries. And if that’s so, is the future of the Republican Party more moderate on all fronts, or more purely ethnonationalist? The Donald Trump question If you survey the modern Republican party, the figures most intent on turning it into a vehicle for ethnonationalist resentment are the least committed to the plutocratic agenda. Steve Bannon, Tucker Carlson, Sen. Josh Hawley, and 2016 candidate Donald Trump are all examples of the trend: they are, or were, explicit in their desire to sever the ties that yoke angry nationalism and a desire for a whiter America to Paul Ryan’s budget. Conversely, the Republican figures most committed to plutocracy — like Ryan or the Koch Brothers or the Chamber of Commerce — tend to back immigration reform, recoil from ethnonationalist rhetoric, and in 2016, they opposed Trump in favor of Jeb Bush and Chris Christie and Marco Rubio. They just lost on all those fronts. Hacker and Pierson emphasize the fact that once in office, Trump abandoned populist pretense and gave the Chamber of Commerce everything it had ever wanted and more. But as with so much else with Trump, it can be hard to distinguish decision-making from disinterest. Trump outsourced the staffing of his White House to the Koch-soaked Mike Pence and his agenda to congressional Republicans. The question, then, is whether the dissonance of his administration represents an inevitability of Republican Party politics or simply a lag between Trump demonstrating the base’s prioritization of ethnonationalist resentment and a politician who will both win and govern on those terms. This is the central unanswered question of Hacker and Pierson’s book: If you cut the plutocrats out of the party, either because bigotry drove them out or campaign finance reform neutered them or the Ayn Rand-rapture ascended them, would their absence lead to a Republican Party that moderates on economics and eases off the ethnonationalism, or would it lead to a Republican Party that moderates on economics so it can more effectively pursue social division? Put differently, do you get 2000-era John McCain or 2020-era Tucker Carlson? I suspect the latter. Phillip Faraone/Getty Images for Politicon Tucker Carlson abandoned conservative economics in favor of a purer, more confrontational ethnonationalism, and it’s made him Fox News’s highest-rated host, and spurred talk of a 2024 presidential run. Hacker and Pierson admit they are assessing the GOP as an elite-led institution, and quite often, that’s probably the right way to look at it. But they end up virtually ignoring the power that Republican voters actually hold and, when they are sufficiently offended, wield. Bush and Rubio and Christie were humiliated in 2016. GOP-led efforts at immigration reform failed in 2007 and 2013. Majority Leader Eric Cantor was deposed by Rep. Dave Brat. The Republican autopsy, which recommended that the GOP become more racially and generationally inclusive, was ignored. At key moments, Fox News tried to support immigration reform and deflate Trump, and it lost those fights, and remade itself in Trump’s image. There are lines even conservative media can’t cross. Hacker and Pierson marshal data showing the very rich are more economically conservative than the median voter, but also more socially liberal. As the GOP becomes more crudely identitarian, there’s some evidence that it’s losing the economic elites who George W. Bush once called “my base”: Contributions from the Forbes 400 have been tipping toward the Democratic Party in recent decades, and there’s reason to believe that’s accelerated under Trump. Hillary Clinton won the country’s richest zip codes in 2016 — a change from past Democratic performance — while Trump’s electoral college win relied on gains among lower-income whites. Hacker and Pierson don’t assess the Democratic Party much in their book, but the future of plutocratic populism likely depends on the direction that coalition takes. Joe Biden’s Democratic Party is a tent restive billionaires might feel comfortable in. Yes, they’ll pay higher taxes, but they’ll also receive competent protection from pandemics, and won’t have to explain away the white nationalists in their ranks. If Bernie Sanders’s vision is the future of the Democratic Party, billionaires will remain in the Republican Party, where they are at least seen as allies. Minoritarian authoritarians The most chilling argument in Hacker and Pierson’s book is that Trump’s rhetoric has focused us on the wrong authoritarian threat. The fear that he would entrench himself as an individual strongman has distracted from the reality that his party is insulating itself from democracy: As their goals have become more extreme, Republicans and their organized allies have increasingly exploited long-standing but worsening vulnerabilities in our political system to lock in narrow priorities, even in the face of majority opposition. The specter we face is not just a strongman bending a party and our political institutions to his will; it is also a minority faction entrenching itself in power, beyond the ambitions and careers of any individual leader. Whether Trump can break through the barriers against autocracy, he and his party—with plutocratic and right-wing backing—are breaking majoritarian democracy. A useful thought experiment in American politics is simply to imagine what would happen if the system worked the way we tend to tell our children it works: Whoever wins the most votes wins the election. In that case, George W. Bush would never have passed his tax cuts nor made his Supreme Court nominations, and neither would Donald Trump. The Republican Party would likely have had to moderate its approach on both economics and social and racial issues, as there’d be no viable path forward that combines an economic agenda that repels most voters and a social agenda that offends the rising demographic majority. As Sen. Lindsey Graham (R-SC) said in 2012, before becoming first Trump’s most slashing critic and then one of his most sycophantic defenders, “We’re not generating enough angry white guys to stay in business for the long term.” As I argue in my book on polarization, which similarly ends with a call for democratization, if Trump had won exactly as many votes in 2016 but lost the election because of it, he and his followers would be blamed for blowing a clearly winnable contest and handing the Supreme Court to the Democrats for a generation. In that world, the toxic tendencies he represents would be weakened, and the Republican Party, having lost three presidential elections in a row, would have been far likelier to reform itself. Its ability to keep traveling the path of plutocratic populism stems entirely from the minoritarian possibilities embedded in America’s political institutions. Andy Katz/Pacific Press/LightRocket via Getty Images Hundreds of activists, mostly women, gathered in front of Trump International in Columbus Circle for a “Not My President!” rally in December 2016. As Hacker and Pierson show, this is a point of true convergence between the identitarians and the plutocrats: Both have lost confidence that they can win elections democratically so they have sought to rewrite the rules in their favor. What hold on power they retain comes from the way American politics amplifies the power of whiter, more rural, more conservative areas — and that’s given the conservative coalition a closing window in which to rig the system such that they can retain control. America does not exist in a steady state of tension between majoritarian and minoritarian institutions. Those institutions can be changed, and they are being changed. A party in power can rewrite the rules in its own favor, and the Republican Party, at every level, is trying to do just that — using power won through white identity politics and geographic advantage, but deploying strategies patiently funded by plutocrats. As Hacker and Pierson write: Recent GOP moves in North Carolina show what’s possible in a closely balanced state. Republicans first took the statehouse in 2010. They quickly enlisted the leading Republican architect of extreme partisan gerrymanders, Thomas Hofeller. A mostly anonymous figure until his death in 2018, Hofeller liked to describe gerrymandering as “the only legalized form of vote-stealing left in the United States.” He once told an audience of state legislators, “Redistricting is like an election in reverse. It’s a great event. Usually the voters get to pick the politicians. In redistricting, the politicians get to pick the voters.” In 2018, North Carolina Republicans won their “election in reverse,” keeping hold of the statehouse even while losing the statewide popular vote. In North Carolina’s races for the US House, Republicans won half the statewide votes and 77 percent of the seats. A global elections watchdog ranked North Carolina’s “electoral integrity” alongside that of Cuba, Indonesia, and Sierra Leone. Meanwhile, the Trump administration has sought to reword the census so Hispanics fear filling it out, in the hope that the political representation they’d normally receive flows to white, Republican voters instead. So far, the White House has been too clumsily explicit about the aims of this strategy for courts to clear it, but that’s a mistake that can easily be remedied by savvier successors. Hacker and Pierson argue that the conservative dilemma matters because conservative parties matter. History shows that democratic systems thrive amid responsible conservative parties — parties that make their peace with democracy and build agendas that can successfully compete for votes — and they collapse when conservative parties back themselves into defending constituencies and agendas so narrow that their only path to victory is to rig the system in their favor. This is the cliff on which American democracy now teeters. The threat isn’t that Donald Trump will carve his face onto Mt. Rushmore and engrave his name across the White House. It’s that the awkward coalition that nominated and sustains him will entrench itself, not their bumbling standard-bearer, by turning America into a government by the ethnonationalist minority, for the plutocratic minority. Further Listening I spoke with Hacker and Pierson about their book, and the questions it raised for me, on my podcast, The Ezra Klein Show. Listen here, or subscribe on Apple Podcasts, Spotify, or wherever you get your pods. 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Joe Biden unable to answer softball questions and media's silence is 'mind-blowing,' says Sarah Sanders
It is "shocking" how quiet the mainstream media is reacting to presumptive Democratic nominee Joe Biden's incoherent answers to "softball" questions, former White House press secretary Sarah Sanders told "Fox & Friends" Thursday.