Ramping up hospital volunteers

 Can a hospital be run mostly with volunteers during a prolonged emergency?

The hypothetical scenario here would be a natural disaster comparable to the recent volcanic eruption in Tonga or Hurricane Maria in Puerto Rico.

• An island in the middle of the ocean far from outside help.
• Population of almost one million people.
• Many medical facilities are clinics located in open areas or near the ocean.
• Fewer than two dozen ambulances (some of which might become incapacitated).
• If the island is hit by a category 3 hurricane with wind speeds between 111 and 129 miles per hour, then 5,000 people would be killed and 20,000 injured.
• The island might be increasingly likely to face a category 5 hurricane with wind speeds over 157 milers per hour, or even over 175 miles per hour.
• The system of public shelters is problematic at best, and (to be honest) perhaps even functionally non-existent.

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The central challenge in this scenario for healthcare would be hospitals becoming overwhelmed with patients, with service disintegrating for all patients.

Moreover, some staff might not able to get to the hospital.

Would it be possible to buttress the nursing staff with an army of volunteers who had very strictly delimited duties?

For example, there would be one category of volunteer that would focus purely on needle-related tasks, such as injections, setting up an IV, and so forth.

Another category of volunteer would work solely on cleaning patients, bathing them, changing the bedpans and the sheets.

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If volunteers could perform half of these tasks during a crisis, it would relieve staff.

There would be administrative challenges, like training large numbers of people during normal times, who would volunteer in hospitals periodically to refresh their skills.

There would be long periods of boredom when a volunteer would not have any tasks to perform, perhaps necessitating the need to branch out into other tasks.

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The line of thinking here is not so much inspired by natural disasters in Puerto Rico or Tonga, as much as by the supply chain disruptions in the USA.

The challenge is to think beyond the quest for ever greater efficiencies that characterize normal times and to find ways to prepare to ramp up for an inevitable yet catastrophic event.

For years, hospital administrators have been cutting back on nurses in order to squeeze out the greatest efficiency from hospital staff.

What is happening in hospitals now is the product of dismissing and ignoring the inevitability of predictable catastrophic “white swan” events.

Even when everyone knows that disaster is going to happen someday, there is complacency and resistance toward preparation and innovation in favor of efficiency during normal times.

https://www.nytimes.com/2022/01/19/opinion/nurses-staffing-hospitals-covid-19.html

We’re entering our third year of Covid, and America’s nurses — who we celebrated as heroes during the early days of lockdown — are now leaving the bedside. The pandemic arrived with many people having great hope for reform on many fronts, including the nursing industry, but much of that optimism seems to have faded.

In the Opinion Video above, nurses set the record straight about the root cause of the nursing crisis: chronic understaffing by profit-driven hospitals that predates the pandemic. “I could no longer work in critical care under the conditions I was being forced to work under with poor staffing,” explains one nurse, “and that’s when I left.” They also tear down the common misconception that there’s a shortage of nurses. In fact, there are more qualified nurses today in America than ever before.

To keep patients safe and protect our health care workers, lawmakers could regulate nurse-patient ratios, which California put in place in 2004, with positive results. Similar legislation was proposed and defeated in Massachusetts several years ago (with help from a $25 million “no” campaign funded by the hospital lobby), but it is currently on the table in Illinois and Pennsylvania. These laws could save patient lives and create a more just work environment for a vulnerable generation of nurses, the ones we pledged to honor and protect at the start of the pandemic.

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The notion that corporate greed lies behind a shortage of nurses might be too moralistic.

Never attribute to avarice that which can be explained by habit.

In the private sector, it only makes sense to limit the hiring of staff in order to keep costs down.

But this logic of the private sector during normal times does not apply to considerations of national security which take into account future crises.

In the military and in public health, a certain bloat might be necessary to allow a rapid ramping up in the face of a sudden crisis.

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Back in 2006, a virologist traveled the world, warning people that pandemics are 100-year events, and the world was due for a major pandemic in 2018.

His big project then was creating a global network of research outposts in the developing world to identify and study viruses when they crossed over from animal to human populations.

In the aftermath of the Covid pandemic, his new project is creating pandemic insurance that major corporations and governments can buy.

https://www.wired.com/story/nathan-wolfe-global-economic-fallout-pandemic-insurance/

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Pandemic insurance might especially make sense if pandemics will now become ten-year events rather than 100-year events.

We now live in a globalized world with vast numbers of humans and their farm animals intruding into wilderness areas.

In 2021, a global blue-ribbon panel co-chaired by Larry Summers says more pandemics will follow and the international community must mobilize now.

https://www.hks.harvard.edu/faculty-research/policy-topics/health/stopping-next-pandemic

The panel’s report rests on chilling foundations. First, that the COVID-19 pandemic represents “the biggest setback to lives and livelihoods globally since the Second World War,” plunging hundreds of millions of people back into poverty, killing an estimated 4 million people, and incurring cumulative losses that have been projected at $22 trillion. And second, that we have entered an “age of pandemics,” and events like the current pandemic may reoccur with frightening regularity in the years to come.

However, the panel did not mention pandemic insurance.

The panel, made up mainly of economic and financial experts, was established in January by the G-20 to address how to best organize the international community’s finances to prepare for future pandemics.

Its detailed report identifies four major areas of prevention, preparedness, and response that need to be addressed: a global surveillance and research network to prevent and detect future threats; more resilient national health systems; the supply of medical countermeasures and tools, to radically shorten the response time to a pandemic and deliver equitable global access; and global governance that ensures coordination and adequate funding.

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Which governments are most likely to buy pandemic insurance?

Ross Douthat recently observed that the pandemic response in America has been local.

Educated, urban areas have adopted conservative measures and rural and sunbelt areas have let the pandemic rip.

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Douthat suggests as the Omicron variant wanes and the American population is largely immune to severe illness, this sets up the possibility of conflict among liberals on policy.

For example, the reasons currently given for masking in schools would largely not apply by the end of February.

Arguments for continued masking of children might even alienate most Democrats, tearing the party apart.

https://www.nytimes.com/2022/01/29/opinion/mask-school-covid-rules.html

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The point here is that these affluent, educated, urban areas that are Covid-paranoid might be more open to purchasing pandemic insurance — which would prepare them for a future pandemic that might strike around 2030.

That pandemic might involve a pathogen that is even more virulent and transmissible than any variant of Covid.

Also, the inconvenient measures that affluent urbanites are now imposing on their own service workforce (like wearing N95s) just might save time and lives in the face of a new pandemic.

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But these urban areas might also want to purchase insurance for natural disasters, which may become more common.

A public rainy-day fund for natural disasters might not work because it would be appropriated by politicians during an economic crisis.

Politicians eventually forget that rainstorms are inevitable.

And when it rains, it pours.

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Here’s an argument that masking in schools should end when the omicron surge comes to an end.

The omicron surge should be ebb around the middle of February.

https://www.nytimes.com/2022/01/28/opinion/masks-covid-children.html

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Actually, the real argument might be, “Should there be any masking at all right now?

First, the surge has already far along its decline.

Second, almost all of the people dying from Covid now are unvaccinated.

In some hospital ICUs, not one of the patients has received even a single does of vaccine.

One quarter of Americans have not gotten even a single dose of vaccine (a figure that might be understated because in order to get a third or fourth dose, some people are lying and saying that it is their first dose).

Not getting vaccinated is extremely risky compared to getting a booster.

People who have received three doses of vaccine are 78 times less likely to die from Covid than the unvaccinated.

https://www.nytimes.com/2022/01/31/briefing/boosters-cdc-covid-effectiveness.html

On average, about 2,500 Americans are dying every day from Covid.

Theoretically, if every American had received a third dose, that number would be lower than three dozen deaths per day.

That’s about one-third of the number of Americans who die on average every day from the seasonal flu.

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The end of universal mask mandates does not mean the end of mask wearing on a voluntary basis.

The availability of high-quality, high-filtration face masks is a game changer.

Having access to a high-quality mask means that one does not have to rely on strangers to also wear masks in order to help protect oneself from Covid.

As Harvard’s Joseph G. Allen has written, “For anyone who fears moving away from universal masking, the great news is that they can continue to wear an N95 mask — along with being vaccinated and boosted — and live a low-risk life regardless of what others around them are doing.” There was a time when N95s were hard to get, but now the Biden administration has started providing them free. And younger kids who can’t wear adult-size N95s can wear KN95s and KF94s.

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There are a few people who might desire to wear a face masks all the time in public.

For instance, some people, like cancer patients and people with severe asthma who are immunocompromised or have underlying health concerns, should wear masks.

Also, epidemiologists have always warned that hospitals are vectors of dangerous and weird bacteria, viruses, and fungi.

They have typically warned people to “AVOID HOSPITALS!”

So, regardless of a pandemic, it might make sense for anybody who visits a hospital to wear a mask.

That might be particularly true for the elderly.

In fact, it might make sense for most visits to the doctor to be at a location that is at some distance from a hospital.

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Also, seasonal masking might become a custom in urban America.

After all, the Japanese wear masks during flu season — a habit that might go back centuries, or to the 1918 flu pandemic, or to the 2002 SARS pandemic.

Japan is a populous, crowded society, so masking has long made sense for the Japanese.

It seems like a no-brainer for urban areas in the 21st century.

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The single biggest takeaway from the debate on masking in schools might be on the need to upgrade the infrastructure of schools, in particular, their ventilation.

Also, it’s not fair that some schools have spectacular infrastructure while others are mediocre or even dilapidated.

It’s not a matter of equality of condition.

It’s a matter of equality of opportunity.

The educational system is unique because it is a primary source of opportunity in the most formative years of the individual.

Also, in the event of natural disasters or wars, schools become the default shelter for the population — whether they are designed for that task or not.

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Essential workers (& omicron)

 The Omicron variant spreads even more rapidly than do earlier variants of Covid, which were themselves highly transmissible.

However, after about a month, the number of people in a particular place who are infected with the omicron variant peaks and then rapidly declines.

In the USA, omicron began to sweep through the population in mid-December.

This probably means that in mid-January, throughout the USA, the number of daily infections will begin to fall.

However, because the number of hospitalizations from Covid lags behind case rates by two weeks, this might mean that hospitalizations will peak in early February.

This could mean that much of the healthcare infrastructure in the USA will literally begin to collapse around the beginning of February.

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A greater question is whether this disintegration of many basic services will also be true of other crucial sectors of society — especially those reliant on essential workers.

One popular argument is that because the omicron variant is not as harshly virulent as the earlier forms of Covid were — especially thanks to vaccines — then its spread should be encouraged.

The problem with this argument is that if a large chunk of the American population is somewhat ill all at the same time, society will temporarily cease to function.

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One of the perceptions surrounding the response to omicron variant is that its virulence is being downplayed by healthcare authorities as a favor to business interests.

In particular, the CDC has recommended that the isolation period for those with mild Covid be reduced to five days, followed by five days of mask wearing.

https://www.cdc.gov/media/releases/2021/s1227-isolation-quarantine-guidance.html

Given what we currently know about COVID-19 and the Omicron variant, CDC is shortening the recommended time for isolation for the public. People with COVID-19 should isolate for 5 days and if they are asymptomatic or their symptoms are resolving (without fever for 24 hours), follow that by 5 days of wearing a mask when around others to minimize the risk of infecting people they encounter. The change is motivated by science demonstrating that the majority of SARS-CoV-2 transmission occurs early in the course of illness, generally in the 1-2 days prior to onset of symptoms and the 2-3 days after.

However, if there is a pragmatic motive that is influencing this policy change, it is not the sacrifice of lives for the sake of business profit.

The pragmatic motive is the fear of serious societal disruption.

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The omicron variant poses a scenario out of the most subtle of plots in science fiction.

Imagine a plague that does not necessarily kill many people, but makes everybody somewhat ill during a one month period, during which time they cannot work for a week.

Civilization would begin to stumble and then crumble during this brief period, although without completely collapsing.

That scenario of limited societal disintegration was not true even during lockdowns in 2020, when essential services remained intact despite a significant death toll.

However, with omicron, at any given time during its initial surge, a large fraction of essential workers are out of the picture, if only briefly.

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During 2020, there was a call to “flatten the curve” in order to protect the healthcare system from becoming overwhelmed with patients on ventilators in the ICUs.

In the first month of 2022, hospitals are once again being overrun — not necessarily in their ICUs, but in their emergency rooms, with Covid patients.

In the USA, in particular, the lack of testing infrastructure means that people who want to be tested for Covid are going to the hospitals to do so (and sometimes getting infected).

But more than relieving pressure on hospitals, in January, 2022, the goal is to get back to work for the sake of society.

That is, hospitals might indeed begin to fail and collapse as staff become ill and patients overwhelm the system.

But the greater concern would be that essential services might begin to disintegrate during the month of January.

https://www.ft.com/content/d07f4559-f4f5-4063-94e7-c322bdcf62ce

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There have been complaints that the CDC is not adequately articulating the science behind its five-day isolation recommendation.

However, even when the science is relatively sound, the nature of public health messaging is to simplify a complex reality — often to the point that the simple message becomes problematic. 

https://www.nytimes.com/2022/01/05/us/politics/cdc-rochelle-walensky-covid-isolation-testing.html

“I don’t think that the C.D.C. guidelines were significantly wrong,” Dr. Tom Frieden, the agency’s director under former President Barack Obama, said of the latest recommendations on isolation for those with Covid. But he added, “I think the way they were released was very problematic.”

Dr. Frieden said there were three rules to putting out public health guidance: it must be technically correct, simple and workable in the real world.

Although real world conditions shape the message, they are not mentioned in the message for the sake of simplicity.

Dr. Walensky certainly had real-world implications to consider: Would it make sense to recommend that people take Covid tests, when they are so hard to find? And with so many people getting infected with Omicron, encouraging them all to stay home for longer than five days could cripple the economy.

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Thus, the issue might be that the CDC is not communicating how its views on omicron take into account the specter of real societal unraveling, if only for a month.

This “omicron scenario” is not being communicated by authorities probably because it is complicated and overwhelming — and also because it lies beyond the scope of the natural sciences.

That is, the Biden administration and the CDC promised to just stick with science.

Thus, insofar as the societal ramifications of omicron lie outside of epidemiology, it is not put at the forefront of public discussion.

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In sum, the goal during the time of omicron is to get back to work as soon as possible after getting sick in order to protect the socioeconomic order from disintegration.

This time, extraordinary measures are not being called for in order to inhibit the spread of the virus.

Notably, there is currently no public call to “flatten the curve” to save civilization.

Importantly, the context of this silence is a society that often resists basic measures — such as masks, vaccines, and tests — that would slow the spread of omicron (and the seasonal flu, as well).

Because basic precautions are only haphazardly observed in American society, the quality and quantity of masks and tests are limited — which makes flattening the curve so much harder.

This is not simply an administrative bungling or a failure of messaging.

Rather, it is a bottom-up, grassroots complacency that distorts pandemic policy.

We cannot take basic precautions in order to flatten the curve to save essential workers because we just don’t feel like it.

Because we won’t flatten the curve, when we inevitably all get sick at the same time, we need to get back to work as soon as possible to prevent societal disintegration.

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All of this revolves around the central role played by essential workers.

Again, in the dark days of 2020, prior to the vaccines, essential workers kept society functioning even during periods of lockdown, when everyone else was sheltering.

During this period, essential workers suffered disproportionately high death rates, but they kept going to work.

With omicron, the death rate might be much lower — but so many people are missing work because so many people are infected.

(For example, New York City Mayor Eric Adams stated that 20% of the city’s police force is currently infected with Covid.)

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Omicron should therefore be understood and framed as a threat to essential workers and the work they do.

Yet, this issue is not visible in the media.

In fact, essential workers themselves seem comparatively invisible to the media when one considers all the issues related to essential workers that go unaddressed.

For example, essential workers are dissuaded from quitting because they would not be eligible for unemployment benefits.

https://www.vox.com/2020/5/5/21245713/unemployment-insurance-recalled-workers-voluntary-quit-state-reopening

The general rule of unemployment has always been that you can’t collect benefits if you quit your job. But what about during a pandemic, when going to work means putting your life at risk?

Apparently, the rule still applies.

As nonessential workers across the country are being recalled to their jobs, they’re experiencing a similar scenario: Sure, you can quit or decline to go back, but that means no more unemployment insurance.

Because there was a scarcity of job openings during the pandemic, essential workers could not quit their jobs and find other jobs — effectively turning them into forced labor.

https://www.washingtonpost.com/outlook/2020/05/21/essential-workers-pay-wages-safety-unemployment/

For nurses, grocery clerks and transportation workers, quitting is not an option right now. The irony is that while these workers are — in the word of the moment — “essential” to consumers and employers, they have zero leverage in the workplace. That’s because the coronavirus pandemic has destroyed almost all the alternative jobs. There’s nowhere to go.

The situation is so stark that we can ask whether extreme economic circumstances have turned the workers we call heroes into something closer to forced labor. If so, that realization ought to shape our public policies: A just society owes much more than minimal pay and a few plexiglass shields to the citizens — and noncitizens — it compels into service.

Moreover, in the USA, hazard pay for essential workers is irregular and uncertain.

https://www.pbs.org/newshour/economy/whos-a-hero-some-states-cities-still-debating-hazard-pay

When the U.S. government allowed so-called hero pay for frontline workers as a possible use of pandemic relief money, it suggested occupations that could be eligible from farm workers and childcare staff to janitors and truck drivers.

State and local governments have struggled to determine who among the many workers who braved the raging coronavirus pandemic before vaccines became available should qualify: Only government workers, or private employees, too? Should it go to a small pool of essential workers like nurses or be spread around to others, including grocery store workers?

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Compelling essential workers to work during a pandemic might be necessary, but it should be compensated with benefits, such as hazard pay.

Another benefit would be state provisions for basic health insurance.

For conservatives, public health care would create “moral hazard” because it would be granted in some cases to those who do not work — and thus presumably do not deserve it.

https://www.newyorker.com/magazine/2017/10/02/is-health-care-a-right

However, most Americans might agree that some limited form of publicly funded healthcare is justly deserved for those who work in essential services.

Public health care for essential workers would not violate moral hazard.

In fact, it would be similar to the benefits granted to members of the military.

Minimal health care provisions for all people might also be needed for pandemic preparedness in order to get people to see a doctor and take tests that would be free.

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Indeed, this highlights the role of public health in terms of national security.

The relationship between public health and national security also means that essential workers would subject to vaccine mandates.

As they used to say back during the world wars, “You’re in the army now”.

https://en.wikipedia.org/wiki/You%27re_in_the_Army_Now_(song)

mRNA tech transfer to China & Russia (open source)

 Developing countries need vaccines to protect their populations and to help prevent the emergence of new variants of Covid.

The current system is not effectively getting vaccines to the developing world.

https://www.nytimes.com/interactive/2021/10/22/science/developing-country-covid-vaccines.html

Across the developing world, hundreds of millions of people are unable to get a vaccine to protect themselves from the ravages of Covid-19, and millions of them have already become infected and died.

Contrary to the protests of corporations that are selling vaccines, there are developing countries that are capable of making their own mRNA vaccines.

Depending on wealthy nations to donate billions of doses is not working, public health experts say. The solution, many now believe, is for the countries to do something that the big American mRNA vaccine makers say is not feasible: Manufacture the gold-standard mRNA shots themselves.

Despite mounting pressure, the chief executives of Moderna and Pfizer have declined to license their mRNA technology in developing countries, arguing it makes no sense to do so. They say that the process is too complex, that it would be too time- and labor- intensive to establish facilities that could do it, and that they cannot spare the staff because of the urgent need to maximize production at their own network of facilities.

“You cannot go hire people who know how to make mRNA: Those people don’t exist,” the chief executive of Moderna, Stéphane Bancel, told analysts.

But public health experts in both rich and poor countries argue that expanding production to the regions most in need is not only possible, it is essential for safeguarding the world against dangerous variants of the virus and ending the pandemic.

The developing countries that are most capable of producing mRNA vaccines are:

• India
• South Africa
• Brazil
• Argentina
• Indonesia

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But it is no longer merely developing countries of the southern hemisphere that are vulnerable to Covid.

The current Russian and Chinese vaccines might not be quite so effective against the omicron variant in terms of antibody response as the mRNA vaccines.

https://fortune.com/2021/12/17/jj-sputnik-sinopharm-covid-vaccines-ineffective-omicron-study/

COVID-19 shots made by China’s state-owned Sinopharm and Johnson & Johnson, as well as the Sputnik vaccine developed by Russia, were found to produce little or no antibodies against omicron in a study, as evidence of the new variant’s vaccine-evading abilities mounts.

Researchers at the University of Washington and Swiss drugmaker Humabs Biomed SA analyzed the efficacy of six vaccines against the highly-infectious and most-mutated Covid variant. Only three out of 13 people who has taken both doses of Sinopharm’s shot showed neutralizing antibodies against omicron. For J&J, this metric dropped to one out of 12 samples. None of the 11 people fully vaccinated with Sputnik generated such antibodies.

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But this is complicated.

For example, in the case of the Chinese vaccine, there may indeed be a lessened antibody response to the omicron variant.

This means that the Chinese vaccines do not protect so well against becoming infected by the omicron variant.

Nevertheless, the Sinopharm and Sinovac Covid-19 vaccines still protect against severe illness, hospitalisation, and death from the Omicron variant.

This is because the Chinese vaccines induce a strong T-cell response.

Human bodies have different layers of immunity.

Thus, when antibodies fail to prevent infection, T-cells, a type of white blood cell that attacks infected cells, can form another layer of defense.

Thus, vaccinated Chinese might become infected by omicron, but these cases of infection will become detached from the previous rates of hospitalization and death.

https://www.scmp.com/news/china/science/article/3162208/omicron-good-signs-sinopharm-and-sinovac-shots-fend-severe

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Nevertheless, there could be new coronavirus variants in the future that would require a powerful antibody response, and not merely rely on T-cells.

In other words, Russia and China need mRNA technology to make vaccines.

This is in everybody’s self-interest.

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The idea here is to provide mRNA vaccine technology to Russia and China.

However, this is not only to protect their populations from future iterations of the SARS-CoV-2 virus.

The Russians and Chinese would then ramp up production of mRNA vaccines for the developing world — for free.

Distributing vast quantities of vaccines that require refrigeration would be a great testament to the infrastructure created by the Belt and Road initiative.

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But more than opening up a new front in the struggle to end a global pandemic, giving mRNA technology to China and Russia would one step in making all vaccine technology open source.

In exchange for the mRNA technology, the Russians and Chinese would have to make public their own secret advances in medical and pharmaceutical science and technology.

All technology related to stemming pandemics would be open-source technology.

https://www.fastcompany.com/90498448/how-open-source-medicine-could-prepare-us-for-the-next-pandemic

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For instance, it might be necessary to develop a system of digitized medical records that would be user friendly and free to the developing world.

Specifically, such a system might prove to be essential during a pandemic to compare data, and not just serve as a high-priced billing system.

https://www.newyorker.com/magazine/2018/11/12/why-doctors-hate-their-computers

Spanish passport for Puerto Ricans?

 Latin Americans are eligible for Spanish citizenship after residing in Spain for only two years.

https://www.identitystrategist.com/latest-updates/one-way-to-get-spanish-citizenship

You can get Spanish citizenship with two years residency

Spain’s approach tolerates dual citizenship. In Spain, this tolerance reaches into centuries of its history as the centre of colonial and religious power.  
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Spanish nationality law operates on the basis of jus sanguinis (Latin for right of blood). Citizenship is conferred by having one or both parents who already citizens. This contrasts with jus soli (Latin for right of the soil), where citizenship is conferred by where you were born. 

It is the Spanish system of jus sanguinis that underpins the specific entitlements of citizens of former Spanish colonies to citizenship. In two years of residency in Spain, citizens of Ibero-American countries (which covers the majority of former Spanish-speaking colonies in South America), Andorra, the Philippines, Equatorial Guinea can apply for citizenship. This is better than the standard residency period of ten years.

Here is a proposal to the King of Spain on behalf the Puerto Rican people:

Rather than become Spanish citizens after two years of residency, Puerto Ricans would be eligible for immediate Spanish citizenship — albeit without the right to vote.

This arrangement would replicate the unusual status of Puerto Ricans within the USA, which confers unique economic advantages but denies certain political rights and powers.

https://en.wikipedia.org/wiki/Political_status_of_Puerto_Rico

The political status of Puerto Rico is that of an unincorporated territory of the United States. As such, the island of Puerto Rico is neither a sovereign nation nor a U.S. state. Because of that ambiguity, the territory, as a polity, lacks certain rights but enjoys certain benefits that other polities have or lack. For instance, in contrast to U.S. states, Puerto Rico residents cannot vote in U.S. presidential elections nor can they elect their own senators and representatives to the U.S. Congress. On the other hand, in contrast to U.S. states, only some residents of Puerto Rico are subject to federal income taxes.^[a] The political status of the island thus stems from how different Puerto Rico is politically from sovereign nations and from U.S. states.

Puerto Ricans with Spanish passports could legally work within the European Union.

That would presumably solve some economic problems for them.

What would be in it for Spain and Europe?

Europe, with its declining fertility rate, needs immigrants.

For instance, in Spain, the fertility rate is 1.24 births per woman.

That is well below the population replacement rate of 2.1 children per family.

In fact, it is even below the average fertility rate of 1.55 births per woman in the European Union.

Of course, all those Puerto Ricans moving to Europe means fewer Puerto Rican workers and consumers in the USA.

The fertility rate in the USA is 1.7 births per woman, also well below the replacement level.

Indeed, Puerto Rico itself already has its own problems with depopulation.

The purpose of giving limited Spanish citizenship to Puerto Ricans would be to give them employment opportunities, but this would accelerated depopulation of Puerto Rico.

The assumption here, however, is that Puerto Rico is economically doomed because of its peripheral, rural nature.

Puerto Rico is a relatively small island in the Caribbean Sea that is closer to Venezuela than it is to Florida.

How would Puerto Ricans feel about the prospect of limited Spanish citizenship that would open the doors of opportunity to the European Union?

To be honest, what Puerto Ricans want for their collective future remains a mystery.

Politically, it is uncertain what exactly Puerto Ricans want for their island because efforts to gauge their opinions have been so biased.

https://en.wikipedia.org/wiki/Statehood_movement_in_Puerto_Rico

Although the previous two referendums (November 2012 and June 2017) also had ostensibly pro-statehood outcomes, the New York Times described them as “marred, with ballot language phrased to favor the party in office”.^[24] For example, the fourth referendum, held in November 2012, asked voters (1) whether they wanted to maintain the current political status of Puerto Rico and, if not, (2) which alternative status they prefer. Of the fifty-four percent (54.0%) who voted “No” on maintaining the status quo, 61.11% chose statehood, 33.34% chose free association, and 5.55% chose independence.^{[25][26][27][28]} Opponents of statehood argued that these results did not show that a majority of Puerto Rican voters support statehood. The June 2017 referendum was, according to the New York Times, a “flawed election” where the turnout was only 23%, in part because most statehood opponents sat out. 97% of votes cast favored statehood.

The November 2020 referendum, by contrast, was the first to ask voters a simple yes-or-no question: “Should Puerto Rico be admitted immediately into the Union as a State?”. There were 655,505 votes in favor of statehood (52.52%) and 592,671 votes opposed (47.48%). The 55% turnout rate equaled that for the simultaneous 2020 gubernatorial race and the 2016 gubernatorial race.

There does not seem to be any great passion for US statehood on the part of ordinary Puerto Ricans.

According to the internet, the real force for giving statehood to Puerto Rico is liberal white Americans who know little about Puerto Rico or its history.

Like so many of the big reforms proposed by the Democratic Party, Puerto Rican statehood has the bonus of eliminating the Democratic Party’s handicap in the Electoral College.

That might be the ulterior motive.

Also, if you ask Puerto Ricans what it is they want, they don’t tend to think of their desires in political terms.

What Puerto Ricans want above all else is to live in same neighborhood as their parents.

It’s a very culturally conservative rural ideal that one also finds throughout the American heartland, a powerful sentiment that binds people to places that are economically obsolete.

So what can be done for Puerto Rico’s economy?

The policy proposals would be predictable.

• Democrats would call for state investments.
• Republicans would call for tax cuts (and abolishing the Jones Act).

If both of these policies were implemented, it might nevertheless have little benefit for Puerto Rico as a whole — except for the most urbanized sections of Puerto Rico.

These are the most affluent places within San Juan, and are full of non-Puerto Ricans.

Ultimately, rural areas and peripheral places are becoming economically obsolete.

Localism & devolution to fix polarization (post-plague chaos)

 Throughout the Covid pandemic, there were predictions that America would fall into chaos or civil war. Instead, one-and-a-half years after the introduction of the vaccines, there is an atmosphere of callousness and hostility punctuated by random acts of senseless violence. That might be disappointing and disturbing, but the direst predictions of organized violence have, so far, not been borne out. However, there is evidence that political polarization is intensifying and becoming a long-term trend. Until recently, although there had been increased combativeness between the two major political parties, this was based on emotion and not ideology, because each of the two parties still contained within themselves considerable ideological diversity. There is evidence that the two parties are now in a new era of increasing internal ideological homogeneity. One of the root causes for political polarization is national economic development and integration, which shifts the focus of individual experience away from the locality and community toward abstract identities based on ideological conflict fostered by the national media. One counterweight against this trend would be to shift the locus of political decisionmaking to the locality and regions, although this move would be opposed by the elites of both political parties based on their self-interest.

In the first year of the Covid pandemic, Americans rushed out and bought a record number of guns. This panic buying seemed to feed upon itself, with soaring gun sales fueling a belief that America was headed toward civil war. In the context of political polarization and street protests, the nation’s mood did seemed headed toward some kind of reckoning. However, there was a sense that politically, the fever broke with the capitol riots of January 6th.

Aside from current events, however, early on there were historians weighing in on the possibility of civil strife in America based on historical precedent, ranging from the 1918 “Spanish flu” pandemic to the 14th-century plague. The real threat of chaos, they wrote, comes after a pandemic. During a pandemic, society becomes a pressure cooker under intense and prolonged compression. When the pandemic subsides, society begins to loosen up and vent all that accumulated frustration and grief. The more devastating and prolonged the plague, the more intense the post-pandemic turmoil will be.

Countries that did well during the pandemic will have less turmoil in its aftermath. That would include America’s western Pacific allies like Japan, South Korea, Taiwan, Australia, and New Zealand. These countries took basic precautions, kept their death rates low, and remained open for business. Those countries can also enjoy a greater measure of societal harmony in the post-vaccination era compared to countries that toggled between lockdowns and the complete abandonment of restrictions.

There is another side of these countries’ pandemic success that is not often discussed. These countries had their people adopt a few simple precautions, but these governments also provided their populations with a sense of normality, entertainment, and emotional outlets. For example, early on the Japanese and Koreans figured out that the virus was airborne and not transmitted by droplets on surface, and so they warned their people to wear masks. Japan in particular warned their people to avoid the “3 Cs”:

1. Closed spaces with poor ventilation.
2. Crowded places with many people nearby.
3. Close-contact settings such as close-range.

Despite this warning and the declaration of a state of emergence, the Japanese kept their hostess bars open. This was done for financial reasons, because bars and restaurants bring in tax revenues and unemployed workers would become a drain on government resources. But keeping hostess bars open in Tokyo probably had the effect of reducing social pressures and providing a sense of continuity and stability. Ideally, such indoor entertainment in Japan should have been moved outdoors because the Japanese did know that the virus was airborne. But the point is that safe outlets need to be found. Closing beaches, parks, and hiking trails in the USA was wrongheaded. Likewise, in 17th-century Italy, an outbreak of the plague was dealt with by selling wine through tiny windows rather than indoors.

In this light, vaccine passports are not ideal. The idea of a vaccine passport is that people would need to prove that they are vaccinated in order to enter a restaurant. This might actually turn some of the public against vaccines, and make it more difficult to promote vaccines in general. But it would it would also subject restaurant workers to the rage of the customers that they would have to confront daily. Also, vaccine passports would raise the emotional tension and sense of compression during a pandemic, which leads to a post-pandemic incivility and strife. The best way to improve vaccination rates is to have community groups engage with and talk to their own people about getting vaccinated. Not only does this raise vaccination rates, but it promotes the infrastructure of public health outreach generally. It also lowers tensions in society. Ironically, the libertarian argument against vaccine passports seems to be valid, but the proper alternative to vaccine passports seems to be a communitarian engagement by community groups with individuals and their families. For example, the poorest region of Germany has the highest vaccination rate thanks to public outreach by community groups:

https://www.nytimes.com/2022/04/12/world/europe/germany-covid-vaccine-strategy.html

Since the rollout of vaccines, America has not fallen into chaos or civil war. Today, there is instead an atmosphere of callousness and malice punctuated by random acts of senseless violence. The new reality might be disappointing and disturbing, but it is comparatively a relief compared to the prospect of organized civil strife. However, there might be a couple of provisos attached to the idea that instead of descending into another civil war, Americans have instead merely transformed into the equivalent of 330 million abrasive New Yorkers.

First, Americans were always known for being unsentimental in their pragmatism. For example, after the 1906 San Francisco earthquake ignited several fires that burned down 500 city blocks over the course of three days, Americans flocked to San Francisco to cash in on the rebuilding. Whereas in other societies, great novels, poems, and operas would be written to commemorate the national tragedy, not so much in America. Likewise, during the worst days of the pandemic in 2020, where European newspapers would print the daily death toll on the top of the front pages of their newspaper, American newspapers would instead print the days stock market data. Rather than view this lack of sentiment as an expression of American “greed” and “ruthlessness”, it might be better to observe layers of paradox in the American personality structure. In the outermost, public layer, there is that famous American friendliness, generosity, and openness, which is underpinned by a democratic egalitarianism that glues the society together in a kind of public religion. One typical criticism is that, at a deeper level, Americans are comparatively distant and self-absorbed, and preoccupied with materialism. But a more positive view is that behind this materialism, at a deeper level still, Americans have a faith in self-fulfillment, self-actualization, and the “American Dream”. Perhaps the pandemic and political conflict have stripped away the outermost layer of public civility, but at the deepest level of their psyche, Americans still might have their famous idealism and optimism about their own lives that can nourish the political culture. But this faith might depend on the condition of the economy and the state of international affairs, which are not as certain as they once seemed.

Second, long-term ideological trends might not bode well for the stability of the American polity. There is a lot of talk that “America is politically polarized”, but that is complicated. People can become polarized emotionally in terms of competition between political parties (“affective polarization”), but this is not ideological conflict. Rather, this is a tribal phenomenon and does not mean that people are in conflict along coherent ideological lines. People like to fight, and often their fights have nothing to do with beliefs. It has been noted for a long time that American politics resembles professional wrestling, with audiences becoming all riled up over contrived battles between celebrity politicians — with actual policy issues and ideological differences becoming lost amidst the wild spectacle.

Indeed, polarization along ideological lines is not true for average citizens because they still maintain a diversity of beliefs. It is the politicians who have become polarized over ideology. This is different from a century ago, when joining a political party for a politician was a matter of ingratiating himself into local patronage networks. Back then, within their own party, politicians had to deal with and regularly socialize with other politicians who did not agree with them ideologically, and this process had a moderating effect. Politicians prided themselves on working with one another and getting a lot of work done, and not grandstanding over ideology. However, as the American economy developed and transformed and became nationally integrated, the political parties took on a national character and began to define themselves according to ideology and not local economic self-interest. The two political parties have subsequently become more ideologically divided against each other.

As the two political parties grew apart ideologically, there was also a growing gap between politically polarized politicians and the ideologically diverse citizenry that voted for them. One can see this among working-class people who belong to labor unions, and who in the 1980s were often just as likely to vote for Ronald Reagan as they were to support a Democratic politician. In contrast, the leadership of the labor unions, especially at the higher levels, fully buys into the broad platform of the Democratic Party. The typical American is politically “multidimentional” and has all kinds of beliefs on all sorts of political issues, whereas elites like politicians are “unidimensional” and predictably adhere to their party’s package deal of political positions.

However, this might be changing. Like politicians, ordinary Americans are becoming ideologically homogeneous and polarized. That is, American voters are losing their “dimensionality” or the unique complexity of their own personal political beliefs and they are becoming like the ideologically polarized politicians that they vote for.

https://www.nytimes.com/2022/05/25/opinion/polarization-politics-red-blue-america.html

That is, if I knew your position on abortion, I didn’t necessarily know your position on health care. [In contrast, among] elites, the dimensionality of the issue space has completely collapsed. If I know where a senator stands on abortion, I know where that senator stands on health care, gun rights, immigration, etc.

The disconnect between the mass public and elites is that the mass public’s attitudes are multidimensional (knowing where someone stands on abortion doesn’t necessarily tell me where they stand on health care), while elites’ attitudes are unidimensional.

That is changing, Lelkes argued, citing the work of Chris Hare in the paper I already mentioned: “Hare (who knows a ton about this stuff) has recently shown that public opinion is now collapsing onto one dimension.”

This new ideological homogenization within each political party — and the future intensification of political conflict which it foretells — brings to mind Roy Amara’s famous adage about forecasting the effects of technology: “We tend to overestimate the effect of a technology in the short run and underestimate the effect in the long run.” For example, there is a lot of talk about how self-driving Teslas are going to change everything soon, but the real changes that autonomous EVs will produce are much farther off in the future and more profound than we can now imagine. Likewise, when social indicators point toward future ideological conflict, that conflict will be both much more distant in future and more extreme than we can now contemplate.

The rise of political polarization might be a story about how both modern governments and economic development foster the homogeneity of modern societies. An example from agriculture might be how there were once thousands of local varieties of apple that were as sweet as candy, but industrialization and long-distance trade promoted the development of a handful of varieties that were hard and round enough to roll along conveyor belts without being damaged, but which lacked the distinct flavor of local varieties. The alternative to such homogeneity in the American diet are local produce and regional cuisine.

In politics, the parallel to being a locavore would be the revitalization of local politics. A classic American version of local democracy would be the New England town meeting. That did not really catch on throughout America, but there might be alternative forms of making the locality central to decision making. One approach might be to collect taxes at the state level (for public schools, for example) and to distribute these revenues to localities on a per capita basis. But this is not popular with elites regardless of their ideology because it runs counter to their financial self-interest.

https://www.nytimes.com/2021/11/09/opinion/democrats-blue-states-legislation.html

A compliment to strengthening local government would be the creation by the federal government of regional governments. Regional government, unlike like local government, is not a reality in the USA. What does it look like abroad?

Regional governance involves the “devolution” of some of the national government’s mission and power.

In the United Kingdom, devolution is the Parliament of the United Kingdom’s statutory granting of a greater level of self-government to:

• the Scottish Parliament,
• the Senedd (Welsh Parliament),
• the Northern Ireland Assembly and
• the London Assembly and to their associated executive bodies the Scottish Government, the Welsh Government, the Northern Ireland Executive and in England, the Greater London Authority and combined authorities.

https://en.wikipedia.org/wiki/Devolution_in_the_United_Kingdom

Devolution differs from federalism in that the devolved powers of the subnational authority ultimately reside in central government, thus the state remains, de jure, a unitary state. Legislation creating devolved parliaments or assemblies can be repealed or amended by Parliament in the same way as any statute.

Again, the assumption here is that the sheer scale of the USA is the source of its political polarization. Over the generations, Americans have turned away from immediate, concrete connection and community and toward national political parties for their tribal identity; now, their values and beliefs are coming to conform entirely to their party’s dominant ideology (and that ideology has itself become more extreme). Indeed, relatively small and isolated countries like New Zealand do not seem to exhibit significant political polarization. If scale is the primary culprit in the escalation of civil conflict based on increasingly uniform values and identities, then localism and regional devolution might conceivably be two effective countermeasures.

Ideology & rhetoric in healthcare (Medicare for babies)

 People have different ways of talking about the ethics of health care policy.

The question is how these ways of talking relate to concepts that have been developed within academia, especially economics.

• Sometimes in ordinary conversation people do not refer specifically to the concepts that economists articulate — but their meaning seems to be identical.
• At other times, people refer explicitly to economic and theoretical concepts — but on closer inspection, these people are actually talking about entirely different ideas.

The concept of “moral hazard” provides an example.

• Conservatives express a skepticism toward the idea of healthcare as a right, which they consider unfair to those who work hard for what they have; and although they do not explicitly talk about “moral hazard”, it consistently seems identical to what they mean.
• Conservative populists, in contrast, use libertarian language to express their frustration at being forced to buy health insurance; but on closer inspection, they are not libertarian and they do not oppose the idea of healthcare as a right.

The concept of “moral hazard” in economics refers to the lack of incentive to guard against risk where one is protected from its consequences.

For example, if the government bails out banks during a crisis caused by irresponsible bank lending, then in the future it becomes MORE likely that banks will again make bad loans.

In daily life, people express opinions that sound similar to the concept of moral hazard. On closer inspection, sometimes they are indeed talking about moral hazard and at other times they only seem to. For example, the surgeon Atul Gawande returned to his hometown of Athens, Ohio to see how people felt about the idea of health care as a right. The sentiments expressed by some of the more conservative residents sound a lot like a wariness of moral hazard.

https://www.newyorker.com/magazine/2017/10/02/is-health-care-a-right

In fact, the whole idea that government would get involved in the financing of health care bothered him. One person’s right to health care becomes another person’s burden to pay for it, he said. Taking other people’s money had to be justified, and he didn’t see how it could be in cases like this.

“Everybody has a right to access health care,” he allowed, “but they should be contributing to the cost.” He pointed out that anyone could walk into a hospital with an emergency condition, get treated, and be billed afterward. “Yes, they may have collectors coming after them,” he said. “But I believe everybody should contribute for the treatment they receive.”

A right makes no distinction between the deserving and the undeserving, and that felt perverse to Maria and Joe. They both told me about people they know who don’t work and yet get Medicaid coverage with no premiums, no deductibles, no co-pays, no costs at all—coverage that the Duttons couldn’t dream of.

“I see people on the same road I live on who have never worked a lick in their life,” Joe said, his voice rising. “They’re living on disability incomes, and they’re healthier than I am.” Maria described a relative who got disability payments and a Medicaid card for a supposedly bad back, while taking off-the-books roofing jobs.

Complaints about people unethically exploiting taxpayer-financed healthcare programs seems identical to the concept of moral hazard. Again, this attitude is also associated with political conservatism.

But conservatism is not identical to what has been called “conservative populism” (although the distinction between these two factions has eroded since 2016). Gawande did not seem to encounter or engage with conservative populists in his visit to his hometown in Ohio. Notably, the “free riders” that conservatives lament are abusing government programs often seem to be … conservative populists.

During the 2016 elections, the BBC News did its own anthropological fieldwork, and engaged with Trump supporters in small-town North Carolina. As with the conservative voters that Gawande conversed with, health care as a right was a hot issue. Unlike conservatives, however, the conservative populists did not have a problem with the idea of universal health coverage provided by the government. Their beef was instead with the Affordable Care Act of 2010. More specifically, “Obamacare” mandates the purchase of private health insurance — and conservative populists cannot tolerate government mandates. As a matter of principle, this would seem to reflect a libertarian desire for minimal government. However, the conservative populist does not have a problem with the idea of universal health coverage in itself.

Conservative populists are not classic libertarians any more than they are classic conservatives. It is difficult to understate just how economically hollowed-out these rural areas have become — yet unlike the individualistic, rational libertarian, the conservative populist will not move to a less blighted area because their hometown is everything to them. Instead, they blame: foreign countries like China, establishment “elites”, and foreigners in their midst. In one case, with the closure of factories, the only good jobs in town were janitorial and were monopolized by Hispanics who had settled on this niche long before the collapse of the local economy. Locals stated that once Trump was elected, the Hispanics would be sent back to Mexico, and locals could then take their place as janitors and custodians (the journalist noted that the Hispanics were actually American citizens). Instead of a libertarian individualist, the rural conservative populist is best understood as tribal. Sometimes tribalism is starkly individualistic, and other times it is collectivist and xenophobic (for example, there is the Arab saying “Me against my brother; me and my brother against our cousin; me, my brother, and my cousin against the outsider.”)

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Another distinction between the libertarian and the conservative populist pivots on the concept from economics of “negative externalities”.

In economics, an externality or external cost is an indirect cost or benefit to an uninvolved third party that arises as an effect of another party’s (or parties’) activity. It exists when the production or consumption of a product results in a cost to a third party. Air and noise pollution are commonly cited examples of negative externalities.

https://en.wikipedia.org/wiki/Externality

Libertarians believe in minimal government in contrast to anarchists who believe in abolishing government. The libertarian believes that government is necessary to protect citizens from negative externalities (as well as to compensate for positive externalities, such as the broad benefits to society from schools and churches). In contrast, the conservative populist is intensely preoccupied with his own rights — but not the rights of others. For example, in the 2017 Netflix documentary “Trophy” about staged big-game hunting in South Africa, an American “hunter” states that according to the Bible man has dominion over nature, and therefore he can do whatever he wants to animals. This type of rationalization typifies how the conservative populist uses orthodox language to defend his own transgression of the orthodoxy. It could be that the libertarian streak that distinguishes American conservatism from its European counterpart is largely an illusion in that that so much of what seems to be classic American individualism is something more complicated. The true American libertarian might be a rarer and more elite character such as an urban professional or a corporate executive as opposed to the less esteemed yet assertive small businessman or worker (or “Karen” who insists on personally complaining to the manager). That is to say, the establishment of the Republican Party (and of the Democratic Party in a qualified way since the 1990s) are libertarian in orientation, and this diverges from the traditionalism of the European conservative establishment (such as the “Tories” in Britain and the Christian Democrats on the continent) which has its own collectivism and is not so adverse to big government. In Europe, the traditionalism of conservative elites trickles down and stabilizes society and promotes social cohesion, whereas in the USA the libertarian philosophy of the business elites sinks deep into the society at large and provides a framework which ordinary people can use against the establishment. This is very much in line with a major theme in cultural studies about how ordinary people slyly and surreptitiously utilize to their advantage the structures of domination that are imposed upon them by authority. However, in the case of the American lower classes — and Americans more generally — when they adopt the libertarian rhetoric of the business elites, it’s also a case of drinking the ideological Kool-Aid and imagining oneself akin to the affluent, educated, and isolated suburban individualist.

In sum, the main distinguishing characteristics for the conservative populist in terms of health care as a right are:

• They don’t object to it in principle, but
• they just don’t want to be forced to buy it.
• They are wary of outsiders accruing public benefits, and
• they mobilize libertarian rhetoric to diminish the rights of others.

So, the libertarian rhetoric of the conservative populist masks a very different set of values from that of the classic libertarian.

All of this puts into question the standard view that Americans have a libertarian bent because they inherited the rugged individualism of frontiersmen like Davy Crockett, Daniel Boone, and Andrew Jackson. First, Americans might trace a certain spirit of independence to the frontier, but the frontier represents community just as much as individualism. Second, it is the capitalist leadership that had the true libertarian ethos, and Americans engage in this libertarian ideology — and sometimes utilize it against the elites.

The rural conservative and the conservative populist are similar to one another in having a starkly communal and collectivist orientation so different from the individualistic libertarian ethos. An article in the New Yorker magazine from 2016 explains that West Virginia’s culture in particular is unlike the rest of the USA in terms of its commitment to community and its fervor for Trump. A recent arrival to a town in West Virginia described how he found out that a local church was praying for him every Sunday; it was not even his church and he had never met those parishioners. But the flip side to this communal spirit is communal hostility. A Black man told of how when his family moved into the West Virginia suburbs, on the street in front of his house there was always a car parked with a few white men keeping the family under constant surveillance, and of how cars would drive past their home and the passengers would shoot at the house. In rural West Virginia, people live in isolated valleys populated by their relatives, and in some cases they have been in those valleys for generations. They have also been staunch Democrats in all that time, and their switch to Republican Party is a wrenching decision. For them, Trump represents everything that the Democratic Party once stood for. Rather than being corrupted by Trump (as the leadership of Democratic Party believes), Trump has shown them the way home.

https://www.newyorker.com/magazine/2016/10/10/in-the-heart-of-trump-country

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Another distinction between the conservative and the conservative populist is the attitude toward authority, with conservatives respectful of and compliant with legitimate authority figures and conservative populists suspicious and resentful of authority.

During the initial phase of the vaccine rollout, the New York Times reported on vaccine hesitancy in rural West Virginia, with some people expressing complete suspicion of vaccines. One person they interviewed said that he would avoid any vaccine and instead put his faith into apple cider vinegar, which he swore cured every affliction that he had ever suffered from. A community leader explained that a distrust of authority — both political and medical — among people in the area ran deep and went back centuries. In fact, he explained that these people are the descendants of what Americans refer to as the “Scotch-Irish” or “Scots-Irish” who originated from the chaotic and violent border regions of Scotland and later settled in Northern Ireland, and so their hostility to authority dates back to long before their immigration to the New World. They may have once been Presbyterians and Democrats, and now they are Evangelicals and Republicans, but their core anti-elitist attitudes and values have not changed that much.

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Another fundamental distinction between the conservative, the libertarian, and the conservative populist is the types of mentality that ground their self-justification.

Conservatives — and liberals — base their agenda on moral concerns, whereas libertarians argue that individual rationality is the proper basis of public policy. As a result, liberals and conservatives sometimes regard libertarians as sociopaths.

.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3424229/

It should be added that progressives like Barack Obama are similar to libertarians in that they regard reason as the proper guiding principle of public policy — although for progressives, this rationality is collective and managerial (for example, Obamacare and public health generally). Perhaps this technocratic tendency of progressives can be off-putting to both liberals and conservatives, who might both regard it as amoral. Indeed, one frequent Republican slur against Obama was that he was a narcissistic sociopath and con-artist.

Perhaps populism on both the left and the right is based on passion and emotion rather than on either morality or reason. The difference between the far-left and far-right might be in the types of emotion that they exhibit. For leftists, it is intense, breathless idealism, and for the right it is rage. In sum:

• Progressives and libertarians frame their views in terms of rationality.
• Liberals and conservatives establish their values on a moral basis.
• Populism is based on emotion.

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In sum, ideological differences that can be obscured under rhetoric. In fact, hiding such divisions is part of the hard work of any political party because political parties are always coalitions. Consequently, identifying the deeper values of all the factions in society can help to forge public policy that would appeal to a broad swath. In terms of avoiding moral hazard as an issue in health care, there are at least three groups of people who are generally perceived as deserving of health care as a right even if they are not directly paying for it:

• military veterans (especially combat veterans);
• the elderly; and
• children.

Medicare for children is especially of interest because funding for early childhood development might be one of the most effective ways of promoting health. Human lifespans have expanded in the developed world for the past century, but the reasons for this might not be intuitive. It has been asserted that the primary reason is not because improved conditions for adults. Rather, humans live longer thanks to improved prenatal health and improved health in the first two years of life — not just during the child’s life, but during that of the child’s mother. Therefore, if a female receives proper care and nutrition while still a fetus in the womb and during the first two years of her life, and later her own offspring do as well, then lifespans begin to grow. This would be the scientific rationale for Medicare for infants. Aside from the policy objective of improved health, such a policy would form a basis of cross-ideological understanding and improved social cohesion. (Of course, there is a question whether Americans actually want social accord because ideological conflict serves as a source of identity when community withers as it has in the USA, and is also a source of entertainment. Some people want to be polarized and do not want to solve problems.)

Promoting participatory sports in schools & colleges

 In American schools that receive federal funds, girls and women are entitled to have sporting teams just as much as the boys and men.

https://en.wikipedia.org/wiki/Title_IX

No person in the United States shall, on the basis of sex, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any education program or activity receiving Federal financial assistance.

— Cornell Law School’s Legal Information Institute (20 U.S. Code § 1681 – Sex)

One criticism of this policy is that sports programs for girls and women created to satisfy the requirements of Title 9 do not get funded like those for males.

There seems to be a tendency to scapegoat school administrators and politicians for not funding female sports.

The reality is that the public has less interest in women’s sports.

Community leaders can feel that they are throwing money away on sports that have a small audience.

It could be that equality in funding school sports will not be achieved until there is a shift toward participatory sports and away from spectator sports. 

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The root problem is that "sports" in American schools refers to spectator sports.

In Europe, the focus in the schools is on participatory club sports.

In Europe, anyone who want to play a sport can join a team and play for enjoyment.

Europeans still love spectator sports.

In fact, Europeans spend more per capita than Americans do on spectator sports.

Europeans are sport-obsessed and are sports elitists just like Americans.

But in Europe spectator sports are privatized.

In the USA, in contrast, spectator sports are so often funded by taxpayers or tuition payers in the schools. 

It’s one version of the American system in which “profits are privatized and risks and costs are socialized”.

It’s a perverse kind of socialism and a self-destructive kind of capitalism.

However, this arrangement is not perceived as a problem in American schools.

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It’s been claimed that an emphasis on spectator sports in the schools has health consequences such as the “obesity epidemic”.

For example, twenty years ago, Iceland had a problem with teenage alcoholics.

That problem has been solved with participatory sports for all students, strict curfews, and public education on the science of brain development in adolescents.

Just like the “Dog Whisperer” Cesar Millan says, a tired dog is a good dog. 

Also, dogs secretly want to have rules, structure, community, and leadership.

The Icelandic policy of participatory sports in the schools feels more natural and normal, and less superficial and spectacular.

That is, spectacle is great — at the national and professional level, and not at the local level.

In fact, it might be best if college spectator sports were to be fully professionalized and privatized.

Athletes would be properly compensated professionals within a certain age bracket.

They would never need to set foot on campus.

So-called “college sports” as such would be run by corporations who would pay a fee and/or royalties to the university.

The games would still be played on campus in order to boost school spirit.

But the real “college sports” and high-school sports would be all the students signing up for all kinds of participatory sports regardless of audience size.

https://www.theatlantic.com/health/archive/2017/01/teens-drugs-iceland/513668/

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The idea is to create an educational system that is more inclusive for students and offers them alternatives and options and choices in terms of participatory sports — and is properly funded.

This system would also teaches all students the discipline and teamwork and sportsmanship and so forth that is so valuable to elite competitive athletes.

Unlike spectator sports, participatory sports would be oriented toward promoting academic performance in the schools.

It would hopefully also reduce social dysfunction like drug use.

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When we think of “college sports”, we often imagine the small, homogeneous colleges of a century ago, where the “student athlete” was someone everyone knew.

Universities today are really corporations that resemble cities — and they need to be run as the corporations that they really are.

Spectator sports need to be run like the business they are because money-losing operations just don’t make any sense.

Also, the athletes need to recognized as professionals who deserve to be financially compensated as such — and they don’t need to take coursework to serve as a locus of identity for the campus.

The real investments should be in:

• physical education,
• public education on brain development, and
• participatory sports for everyone.

Lumping the foreign born

Immigration rates in the USA are almost at the peak they reached a century ago before severe restrictions on immigration were imposed in 1924. About 14% of Americans today are foreign born.

In contrast, Australia’s immigration rate is more than twice that of America’s with 30% of Australia’s population born elsewhere. There is a certain mystery as to why Australia allows a much higher rate of immigration because historically Americans have been more open to immigration. Australians claim that they allow large numbers of immigrants into their country out of economic necessity, but the same economic laws also apply to the USA, where immigration is not as popular as one would expect.

The reason for Australia’s higher immigration rates might be the fact that Australia does not share a land border with any other country — especially a poor and populous country. By this theory, if Australia did hypothetically share land borders with Indonesia and Malaysia, then Australia’s immigration policy might be as restrictive as Japan’s — with almost zero immigration.

There might be a tendency for the human mind to lump together all foreign-born newcomers — whether they are immigrants, refugees, seasonal migrant workers, or migrants without permission to settle. When a society experiences an incoming surge of seasonal migrant workers and migrants without permission to settle, it develops an allergic reaction against immigrants and refugees. It is guilt by association, and although it is not fair, it is reality.

But there is also a reverse phenomenon in which idealists react against restrictions against refugees and immigrants by advocating for totally unrestricted migration of any sort. For example, the New York Times tech writer Farhad Manjoo once wrote that the best way to address Trump-era restrictions on immigration was to adopt the exact opposite policy. He argued that a borderless world would have thriving economies because countries with high unemployment rates would find work for their citizens abroad, and countries with low birth rates would have a new source of workers, taxpayers, and consumers. First, the best way to oppose extremism might not be the articulation of a polar opposite extremist view. Second, the advocacy of a borderless world is not liberal or socialist, but libertarian or anarchist, and it might have been the Democratic Party’s libertarian turn in the 1990s that triggered the backlash from conservative populists (who were, until the 1970s, the core voters of the Democratic Party).

The argument here is that in a future with less unregulated migration and fewer migrants, opposition to refugees and immigrants might diminish. But the 21st-century environmental challenges faced by Central America and the Caribbean are increasingly harsh, and will probably lead to economic and state failures that will, in turn, make mass migration to the USA a constant condition. Because humans tend to conceptually lump together immigrants, refugees, migrant workers and mass migration, hostility toward even modest numbers of refugees and immigrants might intensify. That is not good for the American economy because America needs population growth. Also, there is a moral obligation to accept refugees whose lives are endangered and who have no other options.

The classic example of how unrestricted mass migration can cause a backlash that lasts for generations is Chinese immigration during the gold-rush era, when “ceremonial greetings swiftly gave way to bigotry and violence.”

https://www.newyorker.com/magazine/2021/08/30/america-was-eager-for-chinese-immigrants-what-happened

A few of the features of the story are that:

• immigration to the west coast was largely unrestricted, and pleas by American officials for the Chinese to limit their immigration went unheeded;
• the growth of immigrants from Guangdong province to California grew explosively once gold was discovered in 1849;
• almost all the Chinese immigrants were young men rather than families;
• there was a sense that the Chinese were from an alien civilization and radically different, and while at first that made the Chinese objects of fascination who were welcome, gold-rush era mass migration from China triggered a disgust response that mass migration from Ireland and Germany did not.

To some extent, these are also characteristics of the mass migration to Europe that commenced in 2015. Most indications today are that the migrants have settled into their new homes. However, the political consequences of mass migration to Europe seem to involve a long-term shift toward the extreme right — and this shift might still be in its early stages. This shift is evident in the transformation of French political culture, in which right-wing sentiment that was once taboo is now mainstream. But there is also the subterranean sweep of such sentiment throughout the military and police forces in Germany, as a broad swath of the security forces in Germany conspire to overthrow the German government if it allows another “invasion”. In fact, the reaction against unrestricted mass migration might be permanent. After all, the culminating reaction to young Chinese men flooding into California in the early 1850s was the Chinese Exclusion Act of 1882, which serves as a backdrop to the Immigration Act of 1924. (The Immigration Act of 1965 opened up immigration to non-Western immigrants, but at the time it was seen largely as symbolic and not expected to increase immigration rates; it also favored educated immigrants, which has transformed elite American universities. In fact, the audience for immigration reform at the time might have been Blacks and non-Americans; President John Kennedy republished his 1958 book “A Nation of Immigrants” in 1963, after his electoral strategy shifted away from the white Southern base of the Democratic Party toward urban Blacks, but up until this time Kennedy was focused on the Cold War and lukewarm or even suspicious of the civil rights movement — until the rest of a world still embroiled in decolonization and clueless about American segregation started seeing photographs of Blacks being attacked by police.)

Another example of the tendency to lump together different groups of people into a single stereotype can be found in the way that the public perceives homeless people as homogeneous. For some people, the homeless are “bums” who should be arrested for vagrancy; indeed, in some cases, the homeless are young men sound in mind and body living a care-free, wandering life. For others, the homeless are purely victims of society. It does seem that large numbers of homeless people are schizophrenics who have been forgotten by society in the aftermath of the “deinstitutionalization” of the mentally ill from mental hospitals in the 1970s and the abortive shift to halfway houses. Still other homeless people are intellectually disabled people who in the past would be taken care of in small towns, but are now living in the big city (when they are given a home to live in, so often they will abandon it within weeks for no good reason). And still other homeless people are bright, hardworking, middle-class people who ran into a spell of bad luck. The human brain lumps all these people together into a single group with uniform characteristics — and tends to (mis-)understand them in moralistic terms. This results in an inability for politically divided communities to agree on policy; moreover, when communities are not ideologically divided (like liberal San Francisco), they end up with a one-sided and dysfunctional approach that fails to recognize the complexity of the issues.