Category Archive: Liberty
Comments Off on 3 reasons why the NRA is so powerful
Why is the National Rifle Association such a powerful organization? The reason is that in politics, small but organized groups win.
Politics in Washington is about concentrating and focusing power. Large groups have trouble doing that, but small groups focus power very well. The reason is that effective political groups form if individuals think that they benefit by participating. Social scientists call this the free-rider problem.
Imagine you belong to a club or fraternity. You have a party. People promise to show up the next day to help clean the house. The free-rider problem is that everyone likes having the house cleaned up, regardless of whether they helped clean it. So, who shows up to help clean the house?
Mancur Olson, the renowned 20th-century economist, identified three factors that will help us predict what happens.
- Individual benefits — Not many people enjoy cleaning up the house after a party. Still, in any group, some people always show up for everything. But there aren’t enough of those people to solve the problem.
- Group size — If there are only six people in your frat, it’s easier to get help than if there were a hundred. In a large group, everybody thinks, “Let someone else do it. I’ll just sleep.” But if there are only a few members, you know you need to help.
- Selective incentives — One word: donuts. Or maybe sausage biscuits. Some reward that only goes to the people that actually show up and work for the group.
What does this have to do with the NRA? Suppose you’re opposed to guns and favor stricter gun control laws, but you know the individual benefits to any one person from organizing are very small. Further, if stricter laws are passed, all the supporters win, whether they contributed or not. There are thousands and thousands of people who think that way. So, the potential group size is very large, and it’s hard to organize.
What about selective incentives? Not much hope there, either. If you go to a gun control meeting, all you see is some very earnest people handing out folders and wondering why so few people came to the meeting. Is the NRA different? You bet.Gun rights supporters are not a small group, so group size isn’t the reason. But individual benefits are important because NRA members not only like guns but, in many cases, actually own guns. So, they have something personally at stake in the issue.
Furthermore, if you go to a meeting of pro-gun folks, you’ll get to see … guns! Old guns and rare guns. You can join safety classes and marksmanship classes. Even people who might support gun control would enjoy a gun show.
These sorts of differences explain a lot about our political system generally. Special interest groups that have focused benefits, relatively small numbers, and the ability to offer selective incentives have disproportionate power.
The problem is this means government policy may not be guided by what’s best for the public at large. Organized interest groups are able to control a lot of policy making, even if most people in the unorganized public disagree with them. Perhaps that’s a reason to be wary of giving the government certain powers in the first place.
The article above was adapted from the transcript of a Learn Liberty video featuring Professor Michael Munger, “Why Is The NRA So Powerful?”:
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Why does America put so many people in jail? Is it because we have lots of guns? Lots of criminals? Or lots of laws turning nonviolent people into criminals? Watch this UNSAFE SPACE debate featuring Heather Mac Donald and Prof. Thaddeus Russell.
UNSAFE SPACE is a live show and podcast where comedians do standup on controversial topics, then have a discussion with experts and the audience. See more at UnsafeSpaceShow.com. To view the debate in its entirety, see the full episode here.
Comments Off on Reddit AMA with Professor Ilya Somin of George Mason University
Ilya Somin is Professor of Law at George Mason University. His research focuses on constitutional law, property law, and the study of popular political participation and its implications for constitutional democracy.
Professor Somin has written extensively on constitutional theory, federalism, political ignorance, property rights, immigration, and a wide range of other important policy issues. He is a prolific contributor to the Volokh Conspiracy blog hosted by the Washington Post, and his work has been featured in other major publications such as the Wall Street Journal, New York Times, Los Angeles Times, CNN, USA Today, and Forbes. He’s also the author of several well-received books, including Democracy and Political Ignorance: Why Smaller Government is Smarter (Stanford University Press, Second Edition, 2016), and The Grasping Hand: Kelo v. City of New London and the Limits of Eminent Domain (University of Chicago Press, 2015).
Fans of Learn Liberty will recognize Professor Somin as the star of our popular video, I Can’t Breathe: How to Reduce Police Brutality, and as a regular contributor to our blog, where he has written about the politics of sci-fi and fantasy series such as Star Wars, Star Trek, and Game of Thrones.
Mark your calendar for Tuesday, September 19th at 3:00pm ET and join us for a conversation at Reddit.com/r/Politics where you can ask him anything!
Update: The AMA is now live!
Comments Off on Breaking the wheel of Westeros: why heroes aren’t enough
In a famous scene in Season 5 of Game of Thrones, Daenerys Targaryen compares the struggle for power in Westeros to a spinning wheel that elevates one great noble house and then another. She vows that she does not merely intend to turn the wheel in her own favor: “I’m not going to stop the wheel. I’m going to break the wheel.”
In the world of the show, Daenerys’s statement resonates because the rulers of Westeros have made a terrible mess of the continent. Even those who are not sadistic (like King Joffrey), or venal (like many of the leaders of the great houses) do little to benefit the common people, and often end up making their lot even worse than before. Their conflicts have left Westeros devastated and poorly prepared to face the menace of the undead White Walkers, who are about to invade from the north. Even such seemingly idealistic leaders as Ned and Robb Stark and Stannis Baratheon end up exacerbating the carnage rather than improving things.
Even in earlier, more peaceful times, the ruling class mostly preyed on the people rather than provide useful public goods. Both George R.R. Martin’s Song of Ice and Fire book series and the HBO series based on it drive home the point that Westeros’s political system is dysfunctional and that its problems go beyond the flaws of any one ruler.
Daenerys’s desire to “break the wheel” suggests the possibility of a better approach. But, what exactly, does breaking the wheel entail?
Good Intentions and Flawed Execution
Even in the late stages of the still-ongoing Season 7, Daenerys seems to have little notion of what it means beyond defeating her enemies and installing herself as Queen on Westeros’s Iron Throne. She recognizes that Westeros’s previous rulers — including her father, the “Mad King” Aerys – committed grave injustices. But it is not clear how she intends to avoid a repetition of them.
Even if Daenerys herself can be trusted to rule justly and wisely as an absolute monarch, what will happen after she is gone? Recent occupants of the Iron Throne have had a short life expectancy. None of the last five have died a natural death. In a recent episode, Daenerys’s chief adviser, Tyrion Lannister, asked: “After you break the wheel, how do you make sure it stays broken?” Daenerys has no good answer to this important question.
Unlike most of the other rulers we see in the series, Daenerys has at least some genuine interest in improving the lot of ordinary people. Before coming to Westeros, she and her army freed tens of thousands of slaves on the continent of Essos. She delayed her departure from Essos long enough to try to establish a new government in the liberated areas that would — hopefully — prevent backsliding into slavery.
Nonetheless, it is not clear whether Daenerys has any plan to prevent future oppression and injustice other than to replace the current set of evil rulers with a better one: herself. The idea of “breaking the wheel” implies systemic institutional reform, not just replacing the person who has the dubious honor of planting his or her rear end on the Iron Throne in King’s Landing. If Daenerys has any such reforms in mind, it is hard to say what they are.
Daenerys most recently restated her desire to break the wheel in episode 4 of season 7, when she announced it to a group of captured enemy soldiers. Immediately afterwards, she proceeded to execute two of the prisoners, Lord Randyll Tarly and his son Dickon, because they refused to swear allegiance to her. Daenerys orders one of her dragons to burn them to death.
Lord Tarly is a far from sympathetic character, one who has committed significant injustices. Dickon was, arguably, complicit in some of them. Nonetheless, this is an example of Daenerys ordering a brutal execution of prisoners without any due process, primarily because they refused to “bend the knee” to her.
It is not a massive injustice on the scale of those committed by her enemies and predecessors. But it also does little to reassure the people that the new regime will be fundamentally different from the old. Life and death are still decided by the word of the king or queen, with no institutional safeguard against the abuse of such arbitrary power.
The King in the North
Daenerys’s failure to give serious consideration to institutional problems is shared by the other great leader beloved by fans of the show: Jon Snow, the newly enthroned King in the North. Perhaps even more than Daenerys, Jon has a genuine concern for ordinary people. He at one point even sacrificed his life in an attempt to save them (he was later, of course, resurrected). Unlike Daenerys — to say nothing of the other contenders for the Iron Throne — Jon seems to have little in the way of lust for power. He clearly did not really want the northern lords to make him King in the North, and views the position as more a burden than a privilege.
To an even greater extent than Daenerys, however, Jon does not have any real notion of institutional reform. Almost by default, he accepts traditional institutional forms, including the kingship of the North itself. In fairness, Jon has been preoccupied first with retaking the North from the villainous Ramsay Bolton, and later with preparing for the war against the White Walkers. But there is little evidence that he even perceives the need for institutional change, much less has a plan to effectuate it.
Heroes and Villains vs. Institutions
What kind of institutional reform can realistically be achieved in Westeros? It is difficult to say with certainty. The continent is, after all, a fantasy world, and only its creators can really say what might be possible there.
But in Medieval Europe, on which Westeros is roughly based, parliaments, merchants’ guilds, autonomous cities, and other institutions eventually emerged to challenge and curb the power of kings and nobles. These developments gradually helped lead to the Renaissance, the Enlightenment, and the economic growth that led to modern liberal democracy. Few if any such developments are in evidence in Westeros, which seems to have had thousands of years of economic, technological, and intellectual stagnation.
The characters in the books and the TV show are not the only ones who largely ignore the need for institutional change. We the fans are often guilty of the same sin. Few fans watch the show with an eye to institutional questions.
Rather, we are fascinated by the doings of the more prominent characters. Who will prevail in the struggle for power? Who will score an impressive victory in battle or single combat? Will Cersei ever completely alienate her increasingly disillusioned brother Jaime, with whom she has had a longstanding incestuous relationship? Will Daenerys and Jon finally develop the long-foreshadowed incestuous relationship of their own? Unbeknownst to either, she is likely his aunt.
These are the kinds of questions that excite many fans. Relatively few wonder whether and when Westeros will get a parliament, secure property rights, or establish some semblance of the rule of law.
All of this is entirely understandable. Most of us read fantasy literature and watch TV shows to be entertained, not to get a lesson in political theory. And it is much easier to develop an entertaining show focused on the need to replace a villainous evil ruler with a good, heroic, and virtuous one, than to produce an exciting story focused on institutional questions. Writers and showrunners tend to follow the former approach.
The Star Wars series, one of the few sci-fi/fantasy franchises even more popular than Game of Thrones, is just one of many pop culture products that exemplify the same trend. Game of Thrones/Song of Ice and Fire is comparatively unusual in even raising the possibility that institutional reform is the real solution to its fictional world’s problems, and in making this idea one of the central themes of the story.
The Real World Has a Dangerous Wheel of Its Own
However understandable, the pop culture fixation on heroic leaders rather than institutions reinforces a dangerous tendency of real-world politics. The benighted people of Westeros are not the only ones who hope that their problems might go away if only we concentrate vast power in the hands of the right ruler. The same pathology has been exploited by dictators throughout history, both left and right.
It is also evident, in less extreme form, in many democratic societies. Donald Trump won election by promising that he could solve the nation’s problems through his brilliant leadership if only we gave him enough power: “I alone can do it,” he famously avowed at the 2016 Republican National Convention. Before him, Barack Obama promised that he could transcend the ordinary limitations of politics and bring “change we can believe in.”
More generally, voters are prone to support charismatic leaders who promise to change the flawed status quo, without giving much thought to the possibility that the new policies may be as bad or worse than the old. They also rarely consider the likelihood that real improvements require institutional reform, not merely a new leader. The spinning wheel of Westeros has its counterpart in the wheel of American politics, where one set of dubious politicians replaces another, each promising that they are the only ones who can give us the “change” we crave.
For all its serious flaws, our situation is not as bad as that of Westeros. But we too could benefit from more serious consideration of ways to break the wheel, as opposed to merely spin it in another direction. And our popular culture could benefit from having more stories that highlight the value of institutions, as well as heroic leaders. However much we love Daenerys and Jon, they and their real-world counterparts are unlikely to give us a better wheel on their own.
Comments Off on Expert Answers on the Drug War: Highlights from Prof. Jeff Miron’s AMA
Last week, Professor Jeffrey Miron joined us on Reddit for an “Ask Me Anything” conversation as part of the Learn Liberty Reddit AMA Series.
The conversation focused on Dr. Miron’s 30+ years of study on the effects of drug criminalization. Check out some of the highlights below.
Comments Off on If you want to be free, it’s time to break through your own resistance.
Every morning when I sit down to write, I face what Steven Pressfield calls “Resistance,” a force that has knocked me down more times than I care to admit.
In his book The War of Art, Pressfield describes Resistance as “a repelling force. It’s negative. Its aim is to shove us away, distract us, prevent us from doing our work.” Beginning a new diet or exercise program? Starting a new career? Start a new business? Taking a principled stand? Researching graduate programs or finishing your dissertation? Learning about liberty? Resistance arises, Pressfield explains, whenever you attempt “any act that rejects immediate gratification in favor of long-term growth, health, or integrity.” We have all faced it.You won’t face Resistance when you binge-watch Netflix instead of getting on the elliptical sitting idle in your basement. Resistance will cheer when you eat the donut today and promise to cut back on refined carbohydrates tomorrow. Use work time to check your email, the weather, or Facebook and you won’t feel the force of Resistance.
The consequence of Resistance is the same for all of us. In short, as Pressfield writes, “Most of us have two lives. The life we live, and the unlived life within us. Between the two stands Resistance.”
Why understanding resistance matters
In the grip of Resistance, we rationalize our bad choices and attempt to eschew responsibility. We are mistaken if we believe that Resistance is generated outside ourselves. Pressfield tells us bluntly, “Resistance seems to come from outside ourselves. We locate it in spouses, jobs, bosses, kids.… Resistance arises from within. It is self-generated and self-perpetuated. Resistance is the enemy within.”
Philosopher Eric Hoffer puts it this way in his book on the nature of mass movements, The True Believer:
The tendency to look for all causes outside ourselves persists even when it is clear that our state of being is the product of personal qualities.… It is understandable that those who fail should incline to blame the world for their failure.
If Resistance gets in the way of using our talents and we do nothing to overcome it, what comes from the inevitable personal frustrations? Hoffer observes that liberty is threatened,
People whose lives are barren and insecure seem to show a greater willingness to obey than people who are self-sufficient and self-confident. To the frustrated, freedom from responsibility is more attractive than freedom from restraint. They are eager to barter their independence for relief from the burdens of willing, deciding and being responsible for inevitable failure. They willingly abdicate the directing of their lives to those who want to plan, command and shoulder all responsibility.
Freedom can alleviate frustration, Hoffer explains, because it makes available palliatives such as action. But Hoffer asks, “Of what avail is freedom to choose if the self be ineffectual? Unless a man has the talents to make something of himself, freedom is an irksome burden.”
Frustrated by our own inaction, Hoffer warns, “We join a mass movement to escape individual responsibility, or, in the words of the ardent young Nazi, ‘to be free from freedom.’”
Perhaps, yielding to Resistance, we complain endlessly and boorishly about the bad breaks life has handed us and how unfairly we have been treated. Do we then, as Friedrich Hayek writes in The Road to Serfdom, wish to be “relieved of the necessity of solving our own economic problems?”
You can’t overcome Resistance as long as you think the problem is external. Beaten by Resistance, I have made up alibis and rationalizations. I was too tired, too busy, too upset by events of the day — the self-deception goes on.
Pressfield writes, “Procrastination is the most common manifestation of Resistance because it’s the easiest to rationalize.” We tell ourselves we are going to do the task, just not right now. When we wait for the perfect set of circumstances to face Resistance, we wait a long time. No one’s glass is full of perfect circumstances.
“Not right now” has terrible consequences. Have you ever seen an article that demonstrates the difference in accumulated wealth when you start saving for retirement, for example, at age 25 as compared to age 35? Compounding makes a huge difference in accumulated wealth.Your career capital, like financial capital, is subject to compounding. Those who overcome Resistance and work at what is important to them, grow their career capital; those who yield to Resistance stagnate. If you are not doing what is critical today, tomorrow, and next week, it is very difficult to make it up.
Resistance doesn’t come from the action but from our thinking about the action. The more we fear and resist our Resistance, the stronger our Resistance becomes. As soon as you turn your full attention to the action required, Resistance yields.
There is a moment each morning when you open your eyes to a fresh day. Pause to notice this moment. Then observe how quickly Resistance steps in, reciting your problematical circumstances, your back pain, your 3 pm meeting, your commute, your difficult project. Attend to those thoughts and Resistance already has the upper hand. Let those thoughts pass without engaging them and Resistance yields.
We all have our own flavors of Resistance—simple awareness of the many forms your Resistance takes can help you gently walk around it. There probably won’t come a morning when Resistance won’t arise, but there can come a morning when you won’t fight with or fear your Resistance.
Become more aware of times you catch yourself thinking “not right now.” We always have rationalizations for yielding to Resistances, but yielding creates frustration, and as frustration grows there are consequences for society and the future of liberty. Pressfield puts it this way: “[T]he truly free individual is free only to the extent of his own self-mastery. While those who will not govern themselves are condemned to find masters to govern over them.”
Comments Off on Reddit AMA with Professor Jeffrey Miron of Harvard University
The Learn Liberty Reddit AMA Series continues on Wednesday, August 9th, with renowned economist and professor, Jeffrey Miron, senior lecturer and director of undergraduate studies in the Department of Economics at Harvard University.
Dr. Miron has written over 100 op-eds for publications such as the New York Times, Washington Times, Boston Herald, CNN, Time, Huffington Post, The Daily Caller, and Newsweek. He has also written several books, including Drug War Crimes: The Consequences of Prohibition (2004) and Libertarianism: from A to Z (2010). You may recognize him as the star of one of Learn Liberty’s all-time fan-favorite videos: “Top Three Myths of Capitalism.”
Mark your calendar and join us for the conversation on Reddit, Wednesday, August 9th at 3:00pm ET, where you’ll have the chance to ask him anything!
UPDATE: The AMA is now live!
Comments Off on Vaping bans: How the FDA is making it harder to quit smoking
If you were struggling to kick a habit like smoking that endangered your health, which would you prefer: trying an alternative that, while not perfectly safe, was significantly less harmful, or giving up and sticking with your deadly habit?
The answer seems obvious, and it should. Harm reduction — opting for a product or activity that is not harmless but is better than the existing alternatives — is a common strategy that we use almost unthinkingly.
That principle needs to be applied in public policy, and the FDA’s coming vaping ban shows us why. Because e-cigarettes don’t burn tobacco (they deliver nicotine through a liquid that’s heated until it vaporizes), they are intrinsically less dangerous than smoking tobacco-containing cigarettes — 95 percent less harmful, according to Public Health England. So it would make sense to encourage people who are unable or unwilling to give up the habit completely to substitute vaping for smoking.
England’s rational solution to smoking
England’s Royal College of Physicians urged doctors last year to “promote the use of e-cigarettes, NRT [nicotine replacement therapy] and other non-tobacco nicotine products as widely as possible as a substitute for smoking in the UK,” because they provide “nicotine without the smoke.” As professor Michael Russell, whose research was the foundation for the 1988 US Surgeon General’s report on nicotine addiction, put it simply, decades ago, “People smoke for nicotine but they die from the tar.”
Just this month, Public Health England issued its long-awaited tobacco control guidelines, based on the latest science and health monitoring data. They recommend: “The best thing a smoker can do for their health is to quit smoking. However, the evidence is increasingly clear that e-cigarettes are significantly less harmful to health than smoking tobacco. The government will seek to support consumers in stopping smoking and adopting the use of less harmful nicotine products.”
However, it also recommended that e-cigarettes not be routinely included in “smokefree policies,” which could have the unintended consequence of making it harder for smokers to quit.
In the United States, FDA regulations are denying smokers the opportunity to use e-cigarettes to quit or to reduce risk. Further complicating matters, leading public health groups including the American Heart Association, the American Lung Association, and the American Cancer Society are actively lobbying against e-cigarettes, supporting adding e-cigarettes to “smokefree” policies and misrepresenting the science about both the safety of e-cigarettes and how they can help cigarette smokers drastically reduce their risk.
In June, San Francisco passed a law which would ban all e-cigarette liquids flavors except those meant to taste like tobacco — despite numerous surveys of former smokers who told researchers that it’s these flavors which helped them make the life-saving switch.
Although anti-e-cigarette activists claim that it will take decades to know definitively whether e-cigarettes are less harmful than smoking, we already know a great deal about why cigarette smoking is so devastatingly dangerous: primarily because of tobacco combustion. There’s a reason that, for decades, cigarettes have had nicknames like “cancer sticks” and “coffin nails.”
We also know a tremendous amount about e-cigarettes, the liquid that goes into them, and what comes out and is inhaled. Are they totally “safe?” No. But there’s no question that they are far less harmful than cigarettes, the most dangerous, irredeemable, widely used consumer product ever invented. And we know that many smokers are using e-cigarettes to quit.
The problem with “deemed” tobacco products
Partisan politics in the US Senate blocked an effort to rein in the FDA’s retroactive de facto ban on e-cigarettes, known as the “deeming” regulation. The Tobacco Control Act of 2009 gave the FDA direct authority to regulate cigarettes, but other products, such as e-cigarettes, would have to be “deemed” tobacco products before the agency could extend its regulatory reach over them.
The blocked legislative fix, as outlined in the bipartisan Cole-Bishop rider to the budget bill in May, was a modest but urgent effort to fix part of the Obama administration’s e-cigarette ban. The amendment would have restricted the FDA’s “deeming” regulations and its ill-conceived premarket tobacco application process to e-cigarette products sold as of August 8, 2016, while the existing regulations, which are being phased in, cover e-cigarette products introduced since February 15, 2007, or virtually all e-cigarette devices and liquids.
The Cole-Bishop amendment was approved by the House Agriculture Appropriations Committee and was on its way to becoming law via the budget bill. However, Senate Democrats considered it a poison pill and threatened a government shutdown if it and a range of other minor legislative riders were included in the legislation.
The same day the budget was unveiled, the FDA announced an extension to deadlines related to the deeming regulations. In a web statement to stakeholders, the agency said the extensions “will allow new leadership at the FDA and the Department of Health and Human Services additional time to more fully consider issues raised by the final rule that are now the subject of multiple lawsuits in federal court.”
This announcement implies that the new leadership at the FDA and its parent agency, the Department of Health and Human Services, are having second thoughts about the prospects of defending the flawed regulatory process that led to a retroactive and innovation-stifling regulation that would decimate an entire class of life-saving products.
The Trump administration will now have an opportunity to use the deadline extension to take action within the confines of its legal discretion.
Nullifying the e-cig ban
There’s one approach that could reverse the Obama-era regulation without ponderous rulemaking or the uncertain legislative process: The administration could effectively nullify the deeming regulation. A new administration cannot simply change rules it doesn’t like. It can, however, evaluate the current status and merits of a growing number of legal challenges that assert the agency failed to follow the proper rulemaking procedures and then instruct the FDA and the Department of Justice to stop defending the rule because of the serious and irrevocable harm the rule is causing to public health.
Just as the Obama administration’s Justice Department decided not to defend duly passed legislation that it determined was not legally defensible (the Defense of Marriage Act, for example), the Trump administration has the discretion not to defend a rule that it believes was created with procedural failures.
It appears that the new head of the FDA, Scott Gottlieb, will agree with our formulation. In his Senate confirmation hearing, he alluded to this, perhaps prophetically, in response to questions about how to balance the benefit of e-cigarettes against any risk. “I think a properly constructed and overseen regulatory process should have the capacity under the authorities Congress gave the agency to make these determinations,” he said (emphasis added).
The Obama FDA’s process was both improperly constructed and lacked effective oversight. Nullifying the rule by declining to defend the process by which it was created would also give Congress time to rethink the underlying 2009 Tobacco Control Act, which did not even contemplate e-cigarettes (which were then in an early stage of development).
Gottlieb also stated, “We need to make sure we’re getting the most bang for our regulatory buck. That means being cognizant of risks and being sure that we’re not adding to consumer costs without improving consumer safety.” Spending time and effort on defending the indefensible is hardly a good investment of the FDA’s resources. But most important of all, nullifying the FDA’s vaping ban would save the lives of smokers who would like to quit cigarettes, today and in the future.
Editor’s note: This is an updated and revised version of a piece published at the National Review.
For more analysis on vaping bans, watch this Learn Liberty video:
Comments Off on Highlights from our Reddit AMA with Professor Michael Munger
Last week, Professor Michael Munger joined us on Reddit for an “Ask Me Anything” conversation as part of the Learn Liberty Reddit AMA Series.
Dr. Munger is an esteemed Professor of Political Science, Economics, and Public Policy at Duke University. He has authored/co-authored 7 books and over 200 scholarly articles. A long-time friend of the Learn Liberty project, he frequently contributes to our blog, and has starred in nine Learn Liberty videos.
Check out some highlights from the AMA below.
I think we have become more not less tribal. The Downsian conception of parties is as an information shortcut: people “choose” the party that on average is closer to most of their policy positions. But we seem now to have gone the other way: party allegiance is stronger, and prior. And THEN I infer my policy positions from my tribal allegiance. It really does suggest some problems for traditional rational choice theory. But that’s why Public Choice, and the work Bryan Caplan (for example) is so useful: we should expect that people are stupid about politics. But they aren’t stupid because they are stupid; they are stupid because they are smart!
Comments Off on Doctors violate American women’s rights in delivery rooms every day.
This article contains stories of medical abuse that may be disturbing for some readers.
Most of us understand the importance of knowing our rights against the coercive force of the state. Yet there are other ways in which authority and power intervene to control people in dangerous ways. Coercion can be particularly pernicious when it comes to health care, where tragic violations like those of the Tuskegee experiment have demonstrated that medical authorities are no more trustworthy than political authorities in determining what happens to other people’s bodies.
Unfortunately, such violations are not historical artifacts, and one area where they continue today is maternity care.
Violations of consent during birth
Pregnancy and birth represent a particularly vulnerable time for women’s autonomy, and violations of consent during this time are not uncommon. Kimberly Turbin, for example, is a sexual assault survivor whose doctor cut her perineum 12 times while she is heard clearly verbally refusing consent to an episiotomy in the background.
Her case is disturbing and, unfortunately, not rare. What is rare about her case is that the incident was caught on video, which allowed for a civil suit against the doctor and an eventual settlement. You can read about Kimberly’s case and many other cases of violations of consent during birth here (warning: these stories may be disturbing for some readers). Other examples of violations and assault during birth can be found via the powerful Exposing the Silence Project.
For most relatively healthy women, pregnancy, labor, and delivery may be the only times in their lives when their bodies will be under the control of authority figures over whom, it would seem, they have little power. Women may have no idea what they will confront when they arrive at the hospital. And they may have little idea which procedures are evidence-based, which are not, and which they can refuse.
Just as the ACLU suggests that drivers know their rights when they get pulled over for a traffic stop, all women and their loved ones should read about and understand the rights they have over their bodies and how those rights translate into the real world of medical care.
A broken system
There are many contributing factors to violations of consent during childbirth. Some are related to the government policies outlined in my blog post last month. Others are linked to hospital policies and liability concerns. Some come down to simple conflicts of interest between the provider and the patient.
Physicians and nurses perform birthing procedures every day, on many women. It’s natural for practitioners to take an assembly line approach to care. But for the woman involved, her body is not simply an object to be placed on an assembly line. She’s a human being whose unique experiences and situation require individualized attention and who should retain complete control over her body and what happens to it.
This conflict between medical authority and patient autonomy is difficult to bridge, and the conflict can be seen in private discussions among doctors and nurses about “good” patients who submit quietly to medical authority and “bad” patients who question treatments and insist on taking an active role in medical care.
Submission is expected in hospitals in part because the assumption is that doctors and nurses want to help you. So being a “good” patient and going with the flow seems reasonable.
Putting the hospital’s needs first
Unfortunately, the system is not solely, or even sometimes mainly, set up to help women and their infants. As I mentioned in my last post on childbirth, many hospital protocols do not help women or their infants, but instead reduce the hospital’s liability, increase the staff’s efficiency, or, despite being completely outdated, adhere to hospital culture like vestigial limbs. Examples include mandates against eating or drinking while in labor (which are harmful to women, but reduce liability for hospitals), use of routine IV fluids for laboring women (which are harmful to women and may interfere with breastfeeding later, but which limit liability for hospitals and reduce staff labor load), and routine episiotomies (which are harmful to women and based on outdated research, but still common in some hospitals and practices). You can find more information on evidence-based standards of care here and here, including the research on the examples given above.
Because so much of what can happen in labor is NOT actually in women’s best interests, being informed about what may happen and practicing both giving and refusing consent is imperative.
This is why birth plans – documents laying out a woman’s goals and preferences during birth – while so often ridiculed by the obstetrics community, are so important. Some birth plans, of course, are poorly written and demonstrate a lack of understanding by the women themselves of what happens during labor and delivery. This is why the best birth plans are constructed alongside one’s medical provider, not in isolation. But either way, documenting and paying attention to women’s wishes about what happens to their bodies is an integral and important part of high-quality medical care.
Being an informed patient who can self-advocate is crucial to moving through the medical system in a way that limits harm to both a woman and her infant. Doing so respectfully and politely is important as well, though admittedly not always possible given the stress of the labor and delivery process. But the vast majority of doctors and nurses are practicing medicine in what they know to be a broken system. These workers do not want to harm patients. They went into health care largely to help people. But they have jobs to do in a dysfunctional system, and it’s worthwhile to view them as allies rather than as cogs in the machine. Keep this in mind as you learn about your rights during pregnancy and childbirth.
Women’s rights during childbirth
Fortunately, after a series of tragedies, the courts have set clear standards on many issues surrounding birthing women’s rights. Note, this list is NOT exhaustive, and other organizations are in the process of creating more comprehensive lists (see another example here).
- A woman may refuse any and all medical intervention, regardless of the harm such refusal may cause to the infant. In the eyes of the law, the mother’s right to control what happens to her body trumps any right the fetus has.
- Hospitals CANNOT force a woman to undergo a procedure or treatment without her consent, even to save the life of the fetus (although depending on the stage of pregnancy, the hospital can refuse to treat a woman who rejects one facet of care).
- Women have the right to ask questions about their care and inquire into alternatives.
- A woman has the right to a second opinion. She can also request a different nurse or doctor, if one is available.
- Consent forms signed during prenatal visits or at hospital admission do NOT count as ongoing consent to every procedure. Women have the right to refuse consent to any procedure at any time.
- A woman has the absolute right to leave the hospital against medical advice, though doing so may limit the birth settings and providers available to her and may have insurance coverage implications.
- Women have the right to request to speak to supervisors or to consult the hospital’s administration if they feel their rights are being violated.
- Women have the right to privacy during pregnancy, labor, and delivery. This means the right to control how many people are in the delivery room, for example.
- All women have the right to receive equal medical treatment regardless of their race, disability, HIV status, body mass index, and other factors. Some conditions do increase risks to the mother or infant during labor and delivery. A woman should know if she faces any of these risks and what the evidence-based approach to care is, given her health status.
How women can protect themselves before and during childbirth
- Women should work with their medical providers ahead of time, if possible, to understand the likely scenarios that may develop and to construct a birth plan detailing how they would like to be treated.
- Women should clearly make their wishes known (if possible) during hospital admission.
- If a woman wishes to refuse consent to a procedure, she should make that refusal clear and repeat it as necessary.
- A woman should recognize that unforeseen circumstances may make parts or all of her initial goals for birth irrelevant, but that she always retains the final control over her own body.
- A woman should know the laws in her state that cover interventions on mothers and babies. Hospital staff may imply that a procedure is a legal requirement, but this may be inaccurate, depending on the intervention.
- Hiring a support person such as a doula can help women advocate for themselves during the labor and delivery process. More information on the importance of doulas can be found here.
Other resources to inform and empower
Childbirth Connection – For information on evidence-based care during pregnancy and delivery.
Improving Birth – For information on evidence-based practices and women’s rights during pregnancy, labor, and delivery. Also has an emergency contact form for women whose rights are being violated during labor and who need immediate support.
Birth Monopoly – Advocates for evidence-based maternity care, works against obstetric violence and assault, and advocates against government policies that limit women’s care options.
Human Rights in Childbirth – For education and advocacy on women’s rights during pregnancy and childbirth.
The Joint Commission – Accredits and certifies hospitals in the United States. Violations of patient consent can be reported directly to its website.
Comments Off on Rebellion or stability: Which makes a healthier nation?
As the American Revolution began, Americans threw off the rule of a tyrannical king but in their enthusiasm for their newfound freedom, they set up ineffective governments. For instance, they denied the federal government the power to tax, trusting the state legislatures to pay their share of the war costs.
Americans gave their state legislatures too much power and the governors too little. In turn, the people voted irresponsible legislators into office. The result: legislatures started gobbling up executive power, further concentrating it in their hands.
These imbalances made it onerous to fight the British and became even more problematic after the existential crisis of the war had passed. Many states suffered through economic stagnation. Legislatures enacted a litany of new regulations, only to change them soon after, creating chaos and confusion. The federal government could not pay its debts or its armed forces, leaving natives and the British in Canada free to accost settlers on the frontier. And states made conflicting treaties with European powers, increasing an already tense relationship among the newly formed union.
James Madison: Not so quick to ditch the British way
James Madison thought something radical had to change in order to save the fledging nation. He saw the need to reach back to British roots and create institutions that strengthened the federal government and weakened the state governments. This reflected his Burkean understanding of constitutionalism: old laws have a power that constantly changing laws cannot.
While Madison knew the institutions had to be republican, that did not stop him. He simply changed the definition of republicanism. Previously, many would have said that the people have to participate in legislating as they did in ancient Athens or ancient Rome (what we now call direct democracy). Madison claimed that any representative government and any level of suffrage counted as a republic in the modern age.
Opposing Madison’s approach, Thomas Jefferson embraced the political turmoil of the early USA. He was a strict Lockean contractarian who thought that the people are the “only legitimate fountain of power,” so the people’s representatives should have a great deal of power to change laws — including the power to call a constitutional convention.
Madison wrote Federalist 49 in an attempt to convince Jeffersonians of the value of stability. For Madison, laws had to endure in order to have full effect:
It may be considered as an objection inherent in the principle that as every appeal to the people would carry an implication of some defect in the government, frequent appeals would, in great measure, deprive the government of that veneration which time bestows on everything, and without which perhaps the wisest and freest governments would not possess the requisite stability.
Madison endorsed an enduring Constitution over the volatility associated with a more purely contractarian form of democracy that would require a constant recurrence to the people. He followed Burke’s rationale to a certain extent, seeing a need to maintain stability, forsaking some liberty.
Jefferson: Throwing shade at Shays
From Jefferson’s perspective, however, rebellions and tensions demonstrated the health of a nation. He scoffed at the alarm caused by a small uprising in Massachusetts, Shays’s Rebellion, claiming: “A little rebellion now and then is a good thing, and as necessary in the political world as storms in the physical.”
Jefferson took a more Lockean view, seeing the social contract as the only legitimate source of power for the government. He even went further than Locke, saying that “the dead have no rights” over the living. For that reason, every 20 years — which was a generation in the 1800s — the nation should have a constitutional convention allowing the “right to choose for itself the form of government it believes most promotive of its own happiness.”
We see in these radically differing opinions the two constitutional paths the United States had laid before it: one Burkean and one Lockean. The ultimate decision to take the Burkean path provided the United States with long-term stability. It did, however, come at the cost of a more Lockean version of liberty. Considering the result of the French Revolution, due to Madison’s steady hand, American likely avoided what sometimes comes with more liberty: chaos.
Comments Off on Did big government make us rich?
Why are Western countries like the United States and Germany so much richer today than other countries around the world? We desperately need an answer to this question — both to help us understand the human condition and to help us find practical steps we can take to alleviate global poverty.
One explanation for the success of the West is, in a word, liberty. Over the last few hundred years, classical liberal ideas such as the rights of man and the rule of law put constraints on European governments’ power, which resulted in a strong protection of private property rights. This resulted in meteoric economic growth, which delivered the modern cornucopia of wealth.
But classical liberalism itself had roots in earlier social structures. A school of thought that was prominent in the 1970s and 1980s held that classical liberalism could be viewed as the ideological formulation of living arrangements that the West had already enjoyed for centuries.
In particular, political authority in Europe dating back to the fall of the Roman Empire was fractured, overlapping, and concurrent. Europe in the middle ages and early modernity was characterized by a large number of competing polities with multiple sources of law. In a real sense, lawmakers and lawgivers had to “compete” for the right to adjudicate disputes. The multiplicity of legal codes and polities resulted in a wide “social space” in which de facto individual rights flourished. Classical liberalism, as a system of ideas, developed as intellectuals began to reflect on this lived experience.
It’s obvious why those who are predisposed to liberty would enjoy this explanation. Free countries get rich; unfree countries stay poor. But is it the right explanation?
Government Power and Economic Growth
The European liberalism hypothesis has recently been supplanted by another explanation — state capacity. In brief, this is the idea that economic development requires strong, centralized states to uphold the rule of law and provide crucial public goods.
“State capacity” thus means the ability to govern: to enforce, and perhaps create as well, the rules of the social game. The state capacity literature in economics, as advanced by prominent scholars such as Daron Acemoglu, Timothy Besley, and Torsten Persson, places heavy emphasis on a single, strong, central legal authority. In this framework, the fractured and decentralized legal authorities in medieval and early modern Europe are now seen as antithetical to economic development.
Now, it is undeniable that economic growth in the West did not take off until the rise of modern nation-states. But this stylized fact cannot bear the load the state capacity theorists place upon it. State capacity, as an explanation for development, is actually a black box.
The Black Box of State Capacity
To see why, consider the standard explanation for why private property and markets create wealth: Private property and markets are necessary for the market price system to exist, which coordinates the plans of consumers with the plans of producers. Market prices give producers the knowledge necessary to act in the interests of consumers in the form of profit and loss calculations. Market prices also generate good incentives: everyone prefers making more money to less, all else being equal.
This dual information-incentives argument is the kind of explanation the social sciences require, because it answers the question of how acting individuals can promote ends that none of them intended separately, such as economic efficiency and growth.
State capacity, by itself, addresses neither the information issue nor the incentive issue. While governance institutions obviously began centralizing at the beginning of the modern era, this is just a morphological description of what happened to institutions. On it’s own, that’s insufficient as a causal explanation.
Furthermore, the state capacity literature has a hard time dealing with a very troubling counterexample: the totalitarian states of the 20th century: like the USSR and China. These states had plenty of capacity, as evidenced by their ability to murder millions of their own citizens in acts of slaughter on a scale previously unimaginable. Needless to say, these kinds of things aren’t conducive to economic development.
So if modern nation-states are conducive to economic growth, it must be in conjunction with some other mechanism or group of mechanisms. This implies that whatever is “doing the work” of promoting economic growth, it is upstream of the creation of states.
If we want to understand the wealth and poverty of nations, we must find this elusive “something” and specify how it generates the incentives for those with political power to wield it in the broader social interest, and how they had the information to know whether what they were doing was working.
At its core, development economics is the search for these kinds of explanations. State capacity may or may not be a valuable steppingstone to an explanation, but it is not itself an explanation that social scientists should accept.
So it seems the old hypothesis — that the big ideas of classical liberalism created Western economic growth — is worth another look!