Medicaid Abuse: The Rich Get Richer

Over at The American Prospect, Matt Yglesias is of course correct in observing that complaints about "waste and fraud" in regard to public programs are generally thinly-veiled attempts to eviscerate the programs themselves. So Matt feels understandably nervous about the political purposes to which this current series in the New York Times about massive fraud in the New York State Medicaid program will be put.

That's a valid concern. Progressives naturally have to defend Medicaid by making the obvious point that you don't abolish an activity just because it's associated with waste. (Otherwise the Pentagon would have been razed decades ago.)

But there's another key point here: As with most government programs, the vast majority of the waste and fraud associated with Medicaid goes to line the pockets of venal private enterprises and professionals--doctors, dentists, hospitals, nursing homes, and so on--not the "undeserving poor" or "welfare queens" that inhabit conservative nightmares. (And as the Times series indicates, one of the reasons New York politicians haven't cracked down on Medicaid fraud is the clout purchased by the health care industry with generous campaign contributions.)

This is yet another reason to be on guard against some all-too-common presumptions peddled by Republicans and more than a few Democrats: that injecting "private enterprise" into any activity increases its efficiency, and that small business people (traditionally described as "decent," "hard-working," and "entrepreneurial") are the backbone of our society.

Medicaid fraud is not about poor people ripping off the taxpayers. It's about doctors and business owners getting rich(er) by plundering a program intended to help the poor. Progressives need to make certain this fact isn't obfuscated.

Fear as the Path to Power: Haynes Johnson on Joe McCarthy

Be on the lookout for an important new book by journalist Haynes Johnson. It's called The Age of Anxiety: McCarthyism to Terrorism, and it's due to be published by Harcourt in October (which means books in stores in September). I just finished reading an advance copy, and it's absolutely engrossing.

The bulk of the book is devoted to an account of the life and career of Joe McCarthy. As far as I can tell, most of the story has been recounted in previous biographies (including those by Richard Rovere, Thomas C. Reeves, and Arthur Herman), but although the general outline was familiar to me via cultural osmosis, many of the details were not. A few of the many fascinating, appalling tidbits:

* According to McCarthy's lifelong best friend, judge Urban Van Susteren (yes, Greta's father!), McCarthy "never read books," with one exception: Hitler's Mein Kampf, which he regarded as a handbook of political tactics. "Joe was fascinated by the strategy, that's all," said Van Susteren.

* When not engaged in character assassination for political gain, McCarthy was obsessed with gambling, speculating in risky securities, and other questionable money-making schemes. As a senator, he accepted large fees to speak before conventions of real estate and housing speculators. His host at one such meeting recalled McCarthy's behavior before his speech:

It was a disgusting sight to see this great public servant down on his hands and knees [to shoot craps], reeking of whiskey, and shouting, "Come on babies, Papa needs a new pair of shos." He did stop long enough between rolls to look over the gals his aides brought to him: on some, he turned thumbs down, but if one suited his fancy, he'd say, "That's the baby, I'll take care of her just as soon as I break you guys."

* At a dinner dance honoring a Republican senator in 1950, McCarthy mercilessly taunted and bullied columnist Drew Pearson (who had dared to criticize him in print), finally kicking him in the groin--and later boasted about it to supporters and friendly journalists, who congratulated him.

Johnson makes clear that McCarthy was able to amass a frightening degree of power (despite starting out as an obscure, intellectually unimpressive first-term senator from Wisconsin) because his fellow Republicans found it politically convenient to stifle their disgust over his vicious, dishonest tactics:

Republican moderates, including distinguished figures such as Henry Cabot Lodge and Robert A. Taft, personally had little respect for McCarthy. But they kept their silence. Everyone understood that Communists in government would be a major issue in the midterm elections that fall [1950]. McCarthy, respectable or not, could be the key to Republican victory.

By traveling the country trumpeting his phony charges that the Democrats were shielding Communists in the State Department, McCarthy helped his party gain seats in Congress. For the sake of those seats, Republicans cravenly sucked up to McCarthy and his followers. Even President Eisenhower, whose enormous popularity as a war hero would probably have shielded him had he chosen to confront McCarthy, bent over backward to avoid offending his growing right-wing army. It took years of over-reaching by McCarthy--and his near psychological breakdown during the televised Army-McCarthy hearings--before a significant number of Republican politicians were brave enough to challenge him in public.

All of this horrific history is reasonably familiar, though important enough to bear retelling. Johnson's special contribution in this book is twofold. First, he puts the phenomenon of McCarthyism into its historical context by linking and comparing it to previous periods of national hysteria: the era of the Alien and Sedition Acts under President John Adams; the Red Scare and the Palmer Raids of 1919-1920; and the Depression-era crackdown on suspected Communists led by the House Un-American Activities Committee.

Second, and more important, in the last 70 pages of the book, Johnson carefully traces the links between McCarthyism and the current use of fear-mongering, repression, and phony accusations of disloyalty by conservative Republicans, for whom the "war on terror" today plays the same political role that the battle against "Communist subversion" played for the Republicans of the early 1950s. A couple of choice excerpts:

Out of McCarthyism came the modern conservative movement and the former liberals turned neocons who exercise their greatest intellectual and political influence today--as seen in the major role they played in making the Bush administration's case for preemptive war against Iraq. McCarthyism was a major factor in the rise of the radical Right and the polarization that plagues American life, pitting group against group and region against region, sowing cynicism and distrust, and manipulating public opinion through fear and smear. The so-called culture wars that afflict our public discourse are another of McCarthy's legacies, as is the continuing demonization of liberals, the national press, and others whose values are not those of "real" and "patriotic" and church-going Americans.

. . .

The real story of the moral values factor in [the] 2004 [election] was not that Americans were suddenly shocked into political action by the questions of whether abortion or same-sex marriage should be legal. They were troubled by something more elusive, and powerful: fear of threats external and internal, real and imagined; threats from terrorists lurking in the shadows; threats from Americans practicing "immoral" acts around them; threats from Americans deemed unpatriotic and irreligious; threats to the accepted "American way of life" by "un-American" elements of society. . .

Joe McCarthy understood this well, and played upon the same kinds of fears. With his witch hunts, his hounding of homosexuals, his sowing of suspicions of enemies within, his appeals to Christian conservatives by warning of godless Communism and atheistic beliefs, his targeting of the aliens among us, his attacks on thos who didn't conform to the accepted view of what was "normal," he carved a divisive path that others could follow, and did.

It's no coincidence that some of today's sleaziest political operatives (such as Ann Coulter) have made it their mission to rehabilitate Joe McCarthy. They recognize the straight line that runs from McCarthy to Goldwater to Nixon to Reagan to Bush, which makes recasting McCarthyism in a noble, heroic light necessary to their program of creating a new, fake, right-wing history of the twentieth century.

In setting the record straight by reminding us of the evil legacy of McCarthy, Haynes Johnson does today's Americans a real service.

American Narcissism and 9/11

Last week on NPR's Fresh Air, journalist Charles Sennott was interviewed about the terrorist bombings in England. The London bureau chief for the Boston Globe, Sennott compared the British reaction to 7/7 with the U.S. reaction to 9/11 this way (paraphrasing slightly):

After 9/11, Americans were deeply shocked and kept asking the question, "Why do they hate us so?" In London on 7/7, the question was, "Why did this take so long?"

Allowing for a bit of over-simplification (which is inevitable whenever one generalizes like this), I remember the American reaction to 9/11 much as Sennott does. And in retrospect, it strikes me as strangely myopic.

It would have been more realistic to ask the same question the British have been asking, "Why did this take so long?" After all, it wasn't news that large swaths of the world, including many fundamentalist Muslims, were resentful of American and western policies in the Middle East and elsewhere, and the previous decade had seen a string of lesser terrorist attacks on the U.S. and its allies, including, of course, a failed attempt to destroy the World Trade Center. The only people who should have been surprised about 9/11 would be people who'd spent the past ten years focusing on nothing but TV sports and Monica Lewinsky.

Furthermore, our focus on the question "Why do they hate us so?" has driven Americans (at least as reflected in our national self-dialogue in the media) to obsess once again on our favorite topic, American exceptionalism. The "official" answer to the question "Why do they hate us so?" has become, "They hate us because we are free." Which is a remarkably preening, self-congratulatory explanation, one that requires no reflection or learning and justifies any violent action with which we choose to respond. After all, if "They hate us because we are free," then "They" must simply be evil tyrants whom we have no choice but to bomb or bludgeon into submission.

In her professional work, Mary-Jo occasionally encounters people with the personality disorder known as narcissism, which (in my admittedly crude understanding) is akin to though not identical with the lay definition of the word. A narcissist is completely self-absorbed, unable to empathize with or truly care about other people, and preoccupied with his own self-image. In order to bolster that self-image, he constantly seeks out situations in which he can bask in praise and admiration from other people. Of course, this masks a deep-rooted insecurity and conviction of unworthiness which must be defended against at all costs.

The most dangerous event in the life of such a person is a "narcissistic injury," an intolerable insult to the narcissist's inflated self-image. One common reaction to this kind of injury is to become extremely depressed or even suicidal; another is to lash out violently against others.

It's risky, of course, to apply insights from individual psychology to large groups of people. But I can't help thinking that America's self-image--again, as reflected in the self-talk we encounter daily in the media, as well as in other forms of national dialogue such as depictions of American history in classrooms and museums--smacks of narcissism. (I touched on this theme in my Independence Day post.) Our obsessively self-congratulatory (and increasingly obligatory) "patriotism" seems to require constant references to the unprecedented and unmatched "greatness," "freedom," "generosity," "goodness," and "wisdom" of the American people. We've talked ourselves into a condition where we can't imagine why someone--anyone--could possibly fail to love, admire, even worship us and our way of life. Which means that any criticism of America is not just inaccurate and illogical but virtually insane.

As a result, an event like 9/11 becomes the equivalent of an intolerable "narcissistic injury," and the only possible response is a violent one.

By comparison, the calm, stolid, business-like reaction of the British people and their leaders (to an attack that was admittedly on a smaller scale than our 9/11) seems refreshingly sane and mature. Having apparently accepted some time ago the proposition that the United Kingdom is a nation like any other, with virtues, flaws, friends, and enemies, British authorities didn't feel the need to treat an attack on their homeland as an apocalyptic call to arms. Instead, they are treating it as a matter for law enforcement (the very approach the Bush administration derides) and as a symptom of social, political, and diplomatic problems that must be dealt with intelligently and patiently, over time.

Perhaps one day we Americans can grow up to be like our overseas cousins.

Landmarks of Liberalism

As you might have heard, several weeks ago the conservative magazine Human Events came out with this list of the "Ten Most Harmful Books of the 19th and 20th Centuries" (along with a batch of dishonorable mentions). Some of the "winners" were predictable (The Communist Manifesto, Mein Kampf, Quotations from Chairman Mao), a few were surprisingly obscure (books by Auguste Comte, Theodor Adorno, and Georges Sorel), and still others were just silly wingnuttery (Freidan, Kinsey, Keynes).

Some progressive websites tried to produce parallel lists of "evil" conservative books, but the results weren't terribly interesting; as one blogger pointed out, liberals aren't as talented at compiling lists of enemies as conservatives are. (Our hearts aren't really in it--not vicious enough, I guess.) So I decided it would be more interesting to create a list of "Ten Most Important Liberal Books of the 19th and 20th Centuries," a progressive hall of fame to counter Human Events' hall of infamy, with titles chosen on the basis of their positive influence on societal thought and behavior.

Your nominations are hereby requested. To start the ball rolling, here are a few suggestions:

Uncle Tom's Cabin by Harriet Beecher Stowe. One of the great best-sellers of the nineteenth century, history's most influential anti-slavery tract in the form of a novel.

Civil Disobedience by H. D. Thoreau. Launched the notion of non-violent non-cooperation with an evil government; helped shape the thinking of Gandhi and Martin Luther King.

The Octopus by Frank Norris. Muckraking novel tracing the evil impact that the robber barons had on the working people they exploited.

Unsafe at Any Speed by Ralph Nader and Silent Spring by Rachel Carson. Two titles from the second tier of Human Events' hate list, these books helped found the consumer and environmental movements of the second half of the twentieth century.

The Death and Life of Great American Cities by Jane Jacobs. Brilliant evisceration of the anti-human "city planning" movement that destroyed hundreds of livable neighborhoods during the 1920s-19502.

Hiroshima by John Hersey. Great, simple narrative that helped promote national reconsideration of the morality of America's first use of atomic weapons.

The above titles may seem fairly obvious. Here's a more idiosyncratic personal choice:

Language in Thought and Action by S. I. Hayakawa. One of the founding works of the "general semantics" movement, which sought to promote clear thinking through better understanding of the relationship between words and reality. Although Hayakawa later became a conservative university president and U.S. senator from California, this early book of his conveys a strong message of opposition to all forms of mindless prejudice, bigotry, chauvinism, and magical thinking. I read it when I was around thirteen and found it a remarkable eye-opener. I still wish more people would read and digest it.

What books would you nominate for this list? I'd especially appreciate your suggestions about books on the African-American experience (DuBois? Douglass? King?) and feminism (Millett? Freidan? De Beauvoir?), two of the many vast gaps in my education.

BONUS QUESTION: And what about great liberal movies? When our book group discussed Summer for the Gods, Edward J. Larson's book about the Scopes trial a few weeks ago, I got to thinking (for the first time in years) about that marvelous old picture Inherit the Wind. Not very historically accurate, it turns out, but charged with lively performances by Spencer Tracy and Frederic March as well as a great message of enlightenment and toleration.

That starts my list of liberal movies, followed by To Kill a Mockingbird, Twelve Angry Men, and The Grapes of Wrath. Your picks?

Happy Fourth

Check out this marvelous Independence Day post from Digby, featuring a great passage from Frederic Douglass's famous fourth of July speech. I like this comment by Digby:

I don't subscribe to the chauvinistic notion that says we must hail America as the greatest country the world has ever known, despite the fact that I love America as much as I love my family.

The comparison is an apt one, worth a little further elaboration. Does anyone seriously think that being a good family man (or woman) requires believing that one's family is "the greatest family--the most generous, dedicated, hard-working, caring family--in the history of the world"? What would you think about a father who dedicates several days a year to holding ceremonies to publicly proclaim the greatness of his wife and children (and denouncing anyone who doesn't agree with his assessment of them)?

Obviously such behavior would be considered weirdly unhinged. We all love our families, and many of us would give our lives for them. (In various ways, many of us do.) That doesn't require constant public avowals of our love or declarations of our families' "greatness." We love our families because they're ours, and we figure, quite rightly, that the Herricks next door and the Everetts across town love their families just as much--as they should. The "superiority" of one family over another is irrelevant. Sure, on Father's Day you might give your dad a "World's Greatest Father" T-shirt, but it's just an affectionate gag; you're not surprised or offended when you see three other fathers wearing the same shirt.

That's what real patriotism is like--a mature, unforced, natural love comparable to our love for our families. Instead of which we have the phony patriotism that loudly and continually insists on the unsurpassed greatness of the United States and pushes everyone to echo it--not just on Independence Day but on Flag Day, Armed Forces Day, Memorial Day, I'm Proud To Be an American Day, President's Day, Veteran's Day, Constitution Day, the anniversary of 9/11 . . . how many of these multiplying annual observances am I forgetting?

Thankfully, even in this era of the USA Patriot Act and the new McCarthyism, most normal Americans devote more energy on Independence Day to barbecues and TV sports than to enforced declarations of patriotism. At our house, the menu was burgers, Italian sausages, and a come-from-behind Mets win over the first-place Washington Nationals. Hope you enjoyed your Fourth as much as we did.