How To Tell When Time Is Up

Chrissie Giles investigates how medical professionals deliver diagnoses of terminal illness:

Individual words matter. Professor Elena Semino and colleagues at Lancaster University have been conducting a study of how certain kinds of language are used in communication about the end of life. They’ve created a set of over 1.5 million words, collected from interviews and online forums, where patients, carers or healthcare professionals meet to talk with their peers.

Violence or war metaphors (“battling my disease”, “keep up the fight!”) can be disempowering or disheartening for people with cancer, potentially demanding constant effort or implying that a turn for the worse is a personal failure. But in other contexts, they can empower people, helping someone express determination or solidarity, or bringing a sense of meaning, pride and identity. “You don’t need to be a linguist to realise what metaphors a patient’s using,” says Semino. Doctors should ask: are those metaphors working for the patient at that point? Are they helpful, giving them a sense of meaning, identity, purpose? Or are they increasing anxiety?

Heads Up

I’ll be live-blogging the SOTU at 9 pm tonight, and we’ll be covering other reactions among the blogs and tweets thereafter. Tune in.

Update from a reader:

Know that I’ll be drinking IPA out of my sweet new Dish mug during the State of the Union tonight. One healthy chug every time the camera focuses on a scowling Republican.

The Flu Shot Is Still Worth Getting

Aaron Carroll begs everyone to get some perspective:

I see headlines telling people the vaccine is “only 23% effective”. I’d like a list of all medicines people take, diets they go on, behaviors they change, devices they employ, and procedures they undergo which are better than 23% effective. I’m willing to wager the number is quite low.

In other flu news, Kaleigh Rogers covers research on a “universal” flu vaccine:

If clinical trials go well, a new u​niversal flu vaccine that would treat all strains of flu with a single shot could be just five years away. That would mean a future where nearly 20,000 p​eople won’t die due to a pandemic of the virus. A future where we wouldn’t have to spend a week in bed in misery even though we got​ a fucking flu shot this year.

Researchers at the Icahn School of Medicine at Mount Sinai and at Canada’s McMaster University began developing the vaccine three years ago after the discovery of a subclass of antibodies. When the body encounters influenza, it naturally produces these antibodies, which are able to recognize all strains of flu and mutations of the virus.

Until such a vaccine becomes a reality, Meeta Shah warns that emergency departments (EDs) are being overrun:

When interviewing emergency department directors regarding their experiences with this year’s flu season, I was shocked to hear the numbers.  Some EDs reported volume increases 15 to 25 percent higher in December compared to November or when compared to last December.  One director I interviewed joked that this epidemic was so significant he had colleagues who had coined it “The Flunami.”

Why is this important? Well, increased volumes like this don’t make it easy for an ED to function normally, and puts a strain on resources and staff. You or your loved one may need treatment from an overcrowded ED that is struggling to be efficient amongst this chaos.

The President’s Approval Hits 50 Percent

Obama Bump

Obama’s numbers are on the upswing:

His approval rating has risen nine percentage points in the past month alone, while his disapproval has dropped by 10 points. The gains are pretty even across the board, but the biggest are among Democrats (10 points), moderates (10), Hispanics (22), and even white evangelical Christians (10), who generally tilt heavily toward the GOP. Obama also has gained 19 points among adults younger than 30.

Sargent cautions that it’s “too early to say whether Obama is really in the midst of a sustained recovery”:

But one thing that will be worth watching is whether positive feelings about the economy — and about Obama — boost support for his individual initiatives, particularly those which Republicans are criticizing most bitterly, and whether they scramble the political landscape more generally.

Josh Marshall doesn’t want to read too much into recent polls:

Just as we should probably all resist the urge to write doomsaying chin-scratchers on the end of the Obama dream when the President’s numbers are soft, we should probably equally resist the urge when they’re more robust. The economy is by no means everything. The President won reelection solidly with a still anemic economy. But it’s always the place to start when the numbers move.

Something Harry Enten will be keeping in mind:

The approval rating at which an incumbent president running for re-election goes from an underdog to a favorite is in the high 40s. Obama can’t run again, and the relationship between his approval rating and the eventual 2016 Democratic nominee’s chances is a bit messier. But if Obama’s popularity inches up a bit more, he may go from being a drag on the nominee to an asset.

Nate Cohn comments along those lines in today’s NYT:

The balance of evidence suggests that the break-even point for the presidential party’s odds of victory is at or nearly 50 percent approval. If the only thing you knew about the 2016 election was Mr. Obama’s approval rating on Election Day, you might guess that the Democrats had a 37 percent chance of holding the White House with a 46 percent rating — rather than a 23 percent chance with a 41 percent rating. The difference between 41 and 46 might be worth between one and two percentage points to the Democratic candidate in 2016 — the difference between a close race and a modest but clear Republican victory.

Making It Harder For Cops To Take Your Stuff

That’s what Eric Holder did last week. Drum is pleased:

It’s bad enough that civil asset forfeiture even exists as a legal doctrine, but it’s beyond comprehension that the feds would actively encourage abuse of forfeiture laws by creating a program that allows police departments to keep most of the money they seize. This is practically an invitation to steal money from innocent people. So good for Holder for ending this program. If cops are going to be allowed to seize property from people they merely suspect of crimes—or, in some cases, pretend to suspect of crimes, wink wink nudge nudge—they sure as hell shouldn’t be allowed to keep the stuff and sell it in order to buy themselves a bunch of shiny new toys.

McArdle also welcomes the news:

Libertarians like to say that the nearest thing to immortality on this earth is a government program. Programs change their names or get absorbed into bigger programs, but they rarely just die. I’m pleased to see that there’s an exception to this rule, and it’s one that really matters. We’re all a little bit more free today.

Balko insists that “this new policy is one conservatives should love”:

First and most obvious, civil asset forfeiture is a major affront to property rights, a principle conservatives hold dear. The idea that the government can take your property without ever even charging you with a crime, much less convicting you of one, is a pretty appalling abuse of power. And sure enough, much of the effort to reform these laws over the years has come from the right. (Although to be fair, the laws themselves were pushed heavily by the Reagan administration as part of the 1980s drug war — albeit with little-to-no resistance from Democrats).

The other reason the right should cheer this move is that it’s basically a nod to federalism. Several state legislatures saw civil asset forfeiture as unfair and moved to make it fairer. The suitable sharing program thwarted their efforts. Holder’s move ends that interference. It returns policymaking on this issue to the states. Personally, I think there’s a Fifth Amendment argument to be made that the federal government should actually prevent the states from engaging in the practice. But allowing state legislatures with a conscience to end the practice on their own is a good first step.

Kleiman hopes the new policy has a big impact:

The order excludes federal-state-local task forces, but – if I read it correctly – does include the multi-jurisdictional local task forces where much of the worst mischief has been done; some of those agencies are entirely dependent on forfeiture funds (plus Byrne Grant money) and thus under no control whatever from civilian authorities. There’s more to be done to rein in the forfeiture system, but this is a terrific start.

Jacob Sullum is more skeptical:

Holder’s policy explicitly exempts “seizures by state and local authorities working together with federal authorities in a joint task force,” “seizures by state and local authorities that are the result of joint federal-state investigations or that are coordinated with federal authorities as part of ongoing federal investigations,” and “seizures pursuant to federal seizure warrants, obtained from federal courts to take custody of assets originally seized under state law.”

Since there are hundreds of federally funded “multijurisdictional task forces” across the country, that first exception could prove to be very significant. Holder’s order “does not prohibit the worst uses of the equitable sharing asset forfeiture program, particularly excepting seizures in which there is federal task force participation or direction,” says Eapen Thampy, executive director of Americans for Forfeiture Reform. “As virtually every drug task force I know of has a federal liaison on call, this means business as usual by local law enforcement using civil asset forfeiture through the Equitable Sharing Program to enforce the Controlled Substances Act and other federal statutes. In other words, the exception swallows the rule.”

Even if the new policy ends up having teeth, Leon Neyfakh expects civil asset forfeiture to continue “because the majority of America’s 50 states—42, to be exact—still have laws on the books providing huge incentives for police departments to keep doing it”:

According to Louis S. Rulli, a professor at the University of Pennsylvania Law School who has studied civil forfeiture closely, no fewer than 26 states allow police to keep 100 percent of the assets they seize. And Scott Bullock, a senior attorney at the Institute for Justice—the libertarian public interest law farm—says there are 16 others where police keep 50 percent or more.

“The law has to be changed in the states too,” said Bullock. “This closes one window, but you’ve got to close all the windows.”

The First Legislature To Legalize Pot

Vermont

It could be Vermont’s:

It’s far too early in the process to gauge whether the legislature will approve marijuana legalization. But Gov. Peter Shumlin previously said he’s not opposed to it, although he would like to see more data from Colorado and Washington, the first two states to legalize, before Vermont follows through.

Last week, RAND released a study on the legalization options for the Green Mountain State. Niraj Chokshi reads through it:

If passed, legalization could have big implications for the region. There are nearly 40 times the number of regular marijuana users within 200 miles of Vermont’s border as there are within its borders, RAND estimates. That means the state could see a huge boost in tourism by legalizing, unless of course other states legalize.

Kleiman, who contributed to the RAND report, is excited:

The Vermont process holds out great promise, because the normal legislative process – ugly as it can be – has the possibility of producing a result much more nuanced and more carefully considered from multiple viewpoints than the initiative process, under which propositions are drawn up by advocates with the advice of pollsters, no one ever holds a hearing, and any idea that can’t be explained in a 30-second TV spot has to be dropped. The key point of the RAND report is that there are legalization options other than full commercialization.

But Josh Voorhees makes clear that full commercialization is working out pretty well for Colorado thus far:

Retail and medical weed generated more than $60 million in tax and licensing revenue for the state in 2014, the lion’s share of which is helping to pay for school construction and the regulatory system that legalization requires. Opponents looking to nitpick can—and do—point to the fact that the total is a far cry from the $100 million windfall that state officials predicted at the start of last year. But even though legalization advocates hyped a major influx in tax revenue as a selling point, evaluating legal weed on a metric tied so tightly with consumption has always been an awkward proposition. The goal, after all, was never to encourage more people to light up a joint or gobble down a brownie. More revenue would be better, but too much more would represent its own type of problem.

A Sneak Peek At Hillarynomics

A report released last week by The Center For American Progress is being touted as “the potential seed of [Clinton’s] economic agenda”:

It tackles the issues Americans consistently list as their top priority in polls – jobs and the economy – but in a way that’s less likely to alienate the business community and financial sector, or appear inauthentic to her own identity. The report’s international focus also plays to the former secretary of state’s strengths, and it would allow her to promote lessons she’s learned from her many travels abroad.

Yglesias calls the report “the best guide to what Hillarynomics is likely to look like”:

In some ways, it defies stereotypes of the Clintons as standard-bearers for neoliberal centrism by endorsing fiscal stimulus and a strong pro-labor union agenda while downplaying the strong education-reform streak of the Obama administration. But it’s also notable for the Obama-era liberal ambitions it pushes aside. In the main recommendations for the United States, there’s no cap-and-trade or carbon tax in here, no public option for health care, and no effort to break up or shrink the largest banks. Nor is there an ambitious agenda to tackle poverty.

Instead, you get a multi-pronged push to boost middle-class incomes. After an extended period in which Democratic Party politics has been dominated by health care for the poor, environmental regulation, and internecine fights about Wall Street, Hillarynomics looks like back-to-basics middle-class populism.

However, Frum believes that, with actions like his SOTU address, Obama is trying to force Hillary to adopt his agenda:

Almost as much as a Republican victory, a Clinton succession would punctuate the Obama presidency with a question mark. Obama’s highest priority over the next two years seems to be to convert that question mark into an exclamation point, to force Hillary Clinton to campaign and govern on his terms. Whatever happens after that, he can at least say that it was his kind of Democratic Party—not Bill Clinton’s—that won a third consecutive mandate, after having twice done what Clinton never did: win an outright majority of the presidential ballots cast.

Of course, Hillary Clinton can see all this, too. So can Bill Clinton, perhaps even more acutely. The next fascinating question is: what will they do about it?

In Which The Democrats Finally Get A Clue, Ctd

Among other assessments of the Obama strategy for the next two years (mine here), Cassidy unpacks Obama’s new tax proposal:

On Tuesday night, for once, the policy contents of the speech may well dominate things. Over the weekend, White House aides let it be known that President Obama will propose raising taxes on the very rich, to pay for tax breaks for the middle class. More specifically, he wants to increase the tax rate on capital gains for high earners, from 23.5 per cent to twenty-eight per cent, and he also wants to remove the so-called “step up in basis” loophole, which allows rich families to reduce, often greatly, the amount of taxes they pay on their estates. The money generated by these changes would be used for a variety of purposes, including a modest tax cut for middle-class married couples, an expansion in wage subsidies to low-paid workers, and an expansion of tax credits for students in higher education.

Khimm notes that the “proposal is specifically targeted at the wealth gap, which is actually far greater than the income gap”:

Over the last 30 years, top 1% by earnings received one-fifth of all income; by comparison, the top 1% by net worth owned one-third of the country’s wealth — and in recent years, it’s risen to 42%. That’s because wealth compounds itself over time and is taxed at lower rates than income for rich Americans. And it’s also because many ordinary Americans don’t save enough, and barely half are invested at all in the stock market. (The wealthiest 5% of Americans own more than two-thirds of stocks.)

Neil Irwin remarks that “one way to read President Obama’s plan is that it is a first try at what a post-Obama economic policy vision for the Democratic Party might be”:

It is elegantly sculpted to avoid some of the pitfalls of Obama-era partisan warfare. The president’s first term was an extended battle over stimulus, deficits and the role of government. The administration’s first, polarizing political battle was to enact a fiscal stimulus. Next was to expand the role of government in the health care system. Then, battles over deficit reduction that began when a Republican House took office in 2011 were really proxy fights for both parties, with those on the left pushing for continued stimulus and those on the right using the high deficits as a reason to reshape the scale of America’s social welfare state.

The new plan may stand little chance of passage, but it signals that we are moving into a different phase of the nation’s debates over how the government taxes and spends. As Ezra Klein of Vox tweeted Saturday night, this is the first big proposal of the “post-recession, post deficit panic era.”

Leonhardt declares that “the key to understanding President Obama’s new plan to cut taxes for the middle class is the great wage slowdown of the 21st century“:

The wage slowdown is the dominant force in American politics and will continue to be as long as it exists. Nothing drives the national mood — and, by extension, national politics — the way that the country’s economic mood does, as political scientists havedemonstrated. And nothing drives the economic mood as much as wages and incomes, which are the main determinant of material living standards for most households.

Matt O’Brien calls Obama’s plan “Piketty with an American accent”:

Okay, that’s a little bit of an exaggeration, but not a huge one. Obama’s State of the Union, you see, will call for $320 billion of new taxes on rentiers, their heirs, and the big banks to pay for $175 billion of tax credits that will reward work. In other words, it’s fighting a two-front war against a Piketty-style oligarchy where today’s hedge funders become tomorrow’s trust funders. First, it’s trying to slow the seemingly endless accumulation of wealth among the top 1, and really the top 0.1, no actually the top 0.001, percent by raising capital gains taxes on them while they’re living and raising them on their heirs when they’re dead. And second, it’s trying to help the middle help itself by subsidizing work, child care, and education.

Andrew Sprung is amazed by “the extent to which Thomas Piketty’s tome Capital in the 21st Century, published in the U.S. in January 2014, has focused the U.S. policy debate on income inequality”:

Democrats’ willingness to credit core conservative tenets — that raising taxes on high incomes and investment gains always inhibits growth, that deregulation always spurs it — are melting away. Fresh from their November drubbing, Democrats are beginning to heighten rather than soft-pedal the policy contrasts between the parties. Wounded politically by perceptions that the Affordable Care Act helps the poor at the expense of working people, they are looking for proposals obviously attractive to the middle class. Emboldened by accelerating growth and employment gains, they are perhaps shedding inhibitions about leveling the playing field between workers and management.

Derek Thompson glances at the big picture:

The United States has been, and will quite surely remain in the foreseeable future, the best place in the world for the very rich and an increasingly difficult place to earn a rising inflation-adjusted salary for the country’s bottom half. The road out is not hopeless, and the CAP paper on how the U.S. can learn from the rest of the world offers fine solutions across education, infrastructure, and working with cities to develop talent clusters. But this sort of ambitious policy landscaping is purely fanciful with today’s Congress. In this government, all big ideas are rain dances.

Yglesias agrees:

The White House is at pains to note that most of the individual middle- and working-class tax benefits they are proposing enjoy some measure of bipartisan support. But Obama is proposing to pay for them with what amounts to a series of tax increases on rich people. Republicans have made it very clear over the years that they do not believe that rich people should pay higher tax rates. To embrace this plan would entail not just a spirit of compromise that is generally lacking on Capitol Hill, but for the GOP to totally abandon one of its core economic principles.

Paula Dwyer points out that some of Obama’s proposals have Republican roots. But she argues that Obama just made tax reform less likely:

[A]ll of these details are obscured by Obama’s soak-the-rich message, one that Republicans won’t sign on to, despite their desire to help the middle class. In the past, they would have proposed government spending cuts, yet all the easy trims (and even some tough ones) have been made, and the declining deficit has put them in a tough spot on this issue. That’s a tough spot Obama could have exploited for compromise had he not rhetorically boxed in Republicans.

Regardless, Waldman hopes that Obama will spark a real debate:

You can argue — and many will — that it’s pointless for Obama to introduce significant policy proposals like this when he knows they couldn’t make it through the Republican Congress. But what alternative does he have? He could suggest only Republican ideas, but he wouldn’t be much of a Democratic president if he did that. Or he could offer nothing at all, and then everyone would criticize him for giving up on achieving anything in his last two years. If nothing else, putting these proposals forward can start a discussion that might bear legislative fruit later on. Major policy changes sometimes take years to accomplish, so it’s never too early to start. And if Republicans have better ideas, let’s hear them.