Judging by the news reports I’m reading this morning, it seems very likely that the voters of Georgia have spared Joe Biden from being the only Democratic president of recent memory to enter the White House without a majority in the Senate. It appears that Democrats will hold very narrow majorities in both houses of the Congress.

I want to come out against the prevailing wisdom of what’s likely to transpire over the next year. The prevailing wisdom seems to be that the close partisan numbers will put more power in the hands of moderates who will be able to cobble together compromising majorities to pass legislation. I think that almost the opposite will happen.

Rather than looking at the Republicans and Democrats as each having a small number of moderates (and I mean small—about four names in the Senate are mentioned again and again) and a much larger number of more extreme left wingers among the Democrats and extreme right wingers among the Republicans, I think it’s much more practical to think of the parties as consisting of regular or party members of their respective caucuses and dissident members of the caucuses.

The effect of the narrow majorities will be to put much more power in the hands of the dissidents. In the last Senate those dissident would have been Bernie Sanders, Kamala Harris, and Ben Sasse for the Democrats and Joni Ernst, Marsha Blackburn, Susan Collins, and Lisa Murkowski. In the last House the Democrats’ dissidents would have included Ayanna Pressley and other members of “the Squad” and the Republicans’ would have included Mark Meadows, Brian Fitzgerald, and Tom Reed.

I have always thought the “Hastert Rule” was imprudent. To remind you that rule is that nothing gets to the floor without a support of a majority of the House majority. IMO that’s a formula for ensuring that the legislation that actually gets to the floor is more partisan and ideological and less likely to be enacted than might otherwise be the case. What I think is going to happen in this Congress is sort of the opposite of the Hastert Rule. In courting dissidents in their own caucus legislation that Nancy Pelosi allows to come to the floor will be more left wing than might otherwise be the case.

Said another way, fasten your seat belts, we’re in for a bumpy ride. There will be a lot of loud, angry arguing and it will be very, very difficult to get much that passes the House through the Senate.

There have already been a number of mutations in the SARS-CoV-2 virus. We don’t know how many but there have been at least three notable mutations: the European mutation which appears to be different in some notable ways from the virus that originally spread from China, the mutation recently detected in the United Kingdom which has been claimed to be more contagious than the variants which have already spread around the world, and a newly-identified South African variant.

Here’s my question. What if one of the mutations is not responsive to the vaccines which have already been developed for SARS-CoV-2? What if that variant begins spreading while we’re still early in the process of inoculating against the one we’ve seen? And the existing vaccines can’t be “tweaked” to handle both?

I know what my answer is to the questions and it’s what I’ve been saying for some time but that seems to be completely unacceptable.

The editors of the Wall Street Journal observe:

Since 1965 Medicare has funded the vast majority of residency positions at hospitals, which are essentially apprenticeships for medical school graduates. During the early 1990s economists and physician groups sounded alarms about a physician glut—their theory being that more doctors would result in needless treatments and health spending.

Congress responded in the Balanced Budget Act of 1997 by capping Medicare-funded residency positions at 1996 levels and paying hospitals to eliminate positions. Health-maintenance organizations were supposed to limit health-care utilization and spending while the population and demand increased.

Yet introductory economics teaches that prices will rise when demand increases and supply stays the same. This has happened in health care. Government has kept a lid on physician fees for Medicare and Medicaid, but doctors increased rates charged to private insurers to compensate. Hospitals have also discovered they can generate more revenue if in-house doctors perform more treatments. So hospitals have acquired independent physician practices, which has reduced competition and driven up health spending. ObamaCare’s payment models accelerated these trends.

Another problem Congress overlooked is the aging U.S. population and physician workforce. A third of the 906,000 or so practicing doctors in the U.S. are over age 60, and the Association of American Medical Colleges (AAMC) forecasts a physician shortage of 54,100 to 139,000 physicians by 2033. Shortages will be especially acute in geriatrics, primary and emergency care.

Medical schools are expanding enrollment, but graduates face a bottleneck because there are too few GME positions—only 120,000 or so, and each lasts about three to five years. Some hospitals fund residencies from their own budgets—e.g., charging more to privately insured patients—but rural and low-income hospitals are less able to do so.

Some health economists say technology and nurses can substitute for fewer doctors. We support relaxing state licensing regimes to let physician assistants and registered nurses provide more care, but the pandemic has highlighted the limits of this strategy and the U.S. faces a nurse shortage too.

Over the last 60 years we have made up for the shortfall in doctors by importing internationally-trained professionals. In that we are in competition with every other developed country. Additionally, the number of nurse-practitioners and physician assistants is growing at roughly the rate at which the population is increasing. Translation: on their own they can’t make up for a shortfall in physicians.

The problem goes all the way back to 1965. Funding medical residencies through Medicare was part of the devil’s bargain that enabled the Congress to enact Medicare and Medicaid at all. Attempting to manage supply centrally routinely produces alternating surpluses and shortages. Attempting to control costs means that shortages are far more likely than surpluses. An additional complication is that the training takes a very long time and the pool of candidates is fairly small. In econ-speak the supply of physicians, nurse-practitioners, and physician assistants is relatively inelastic.

Technology could, indeed, help to fill the gap but that in turn would require changes in regulations and fundamental changes in how care is delivered that are deeply opposed by present practitioners.

I’m not actually sure what Scott Gottlieb is suggesting in his Wall Street Journal op-ed:

The federal government built a Covid vaccine delivery scheme to track every dose shipped to the states. Information like location and travel history is available in a software platform developed for “Operation Warp Speed” called Tiberius, so that public-health officials can make sure the limited supply is allotted carefully and fairly.

These are important goals, but central control comes with a trade off: it slows down the process of getting shots into arms. Poor local and state planning hasn’t helped. Neither has the trickle of funds the feds have provided to stand up vaccination sites. Add it all up and you have the explanation for the sluggish pace of immunization. Fewer than 5 million people have been vaccinated so far, versus the 20 million promised. Here’s what’s needed to turn things around.

First, the government needs to ship more inventory. Right now, the feds are holding back up to 55% of doses. The idea is to make sure there is supply to give everyone a second dose, within three weeks for Pfizer and four weeks for Moderna.

Sticking to the dose schedule is essential, but supply is expanding and the production processes are proven. Some of the future supply can be given as second doses in those being vaccinated today. The very small possibility that a production snafu could delay second shots seems a reasonable risk to take.

Second, the distribution system needs improvement. Standing up vaccination sites and encouraging people to go get the shot is expensive and takes time. The best option may be to rely more on private industry. National pharmacy chains like CVS and Walgreens have an agreement with the federal government to provide vaccines to long-term care facilities. The government should expand this program to help vaccinate all Americans.

The major pharmacy chains combined can deliver up to 100 million vaccines a month. The plan had been to allow large retailers to start offering the shot when it was ready for the general public, perhaps later in the spring. Why not get started now? Public-health agencies can focus their resources on providing access to harder-to-reach communities and patients who might be homebound.

CVS and Walgreens have been part of the rollout since the beginning. Expanding the number of sites would not seem to be helpful until more supplies of the vaccine are available. Many states and localities are reporting that they haven’t been able to inoculate people fast enough which suggests that supplies of the vaccines are not presently the bottleneck although they may be shortly.

It sounds to me as though the primary bottlenecks are more related to staffing and distribution issues derived from different state and local priorities than anything else. What am I missing?

All I can say about the announcement by Aetna that it will exclude Walgreens from receiving reimbursements under its Illinois Medicaid plan is that CVS/Aetna is a vertically integrated monopoly acting in a way that injures customers. It’s a textbook case for being sued under antitrust laws.

Pharmacy chains owning insurance companies are monsters that should not be allowed to exist. Forcing it to accept Walgreens as well is not a solution. The only solution is breaking the company up.

The editors of the Wall Street Journal speak out against the movement among Republicans to vote against certifying Joe Biden’s election to the presidency:

As Americans like to tell the world, a hallmark of democracy is the willingness to accept defeat and the peaceful transfer of power. The tragedy of the last two presidential elections has been the refusal of partisans to accept defeat, and public trust in American self-government is eroding as a result.

Democrats in 2016 abused the FBI to push the Russia collusion myth and refused to accept Donald Trump’s legitimacy. Hillary Clinton still doesn’t. Now some Republicans are returning the disfavor by challenging the ritual counting of the Electoral College votes by the new Congress this week. Neither one justifies the other, and these columns have called out Democrats for their anti-democratic panic attack.

But the main issue now is that too many Republicans refuse to accept Mr. Trump’s defeat. More than 100 House Members and, as of this weekend, at least 12 Senators say they will formally object to the Electoral College count. This won’t change the result, though it will delay it as Congress spends up to two hours debating the objections to each state’s results. More corrosive will be the precedent and resulting political damage.

The leading culprit here is Mr. Trump, who as always refuses to accept responsibility for defeat. Recall that he also claimed the Iowa caucus result was stolen in 2016 when he lost to Ted Cruz. He’s now spinning conspiracy theories and election falsehoods daily on Twitter. He doesn’t seem to care what damage he does in promoting the myth of his victory.

As I wrote a month ago it’s over. Joe Biden will be the next president of the United States. Now it’s time to pray for his continuing good health.

There’s a furor in many media outlets over a phone conversation between President Trump and Georgia’s head election official. Rather than fulminating about the phone conversation I’ll limit my remarks to this. Here’s what should happen:

• On January 6 the Congress should count the votes of the Electoral College and certify the vote.
• Joe Biden should be sworn in as president on January 20.
• President Trump should go back to doing whatever it is he does.
• I think that President Biden should issue a blanket pardon for President Trump but I don’t believe he will.
• Opinion writers should discover something other than Trump to write about. I think they’ll continue complaining about Trump for years.

Here’s what should not happen:

• Republicans should not oppose the certification. I thought that Democrats were wrong in opposing the certifications of George W. Bush in 2001 and 2005 and I think the Republicans are wrong now. A lot of Republicans will go ahead and oppose it anyway.
• The House should not impeach President Trump again. It’s a waste of precious time and energy. They have more important things to do.
• The House should not refuse to seat Trump-supporting Republicans. That is a slippery slope we do not wish to set foot on.
• Democrats should not blame Trump for everything bad that happens going forward. Blaming him for things that went wrong during his term of office is fair game.

After reading Kwame Onwuachi’s and Alice Waters’s op-ed in the Washington Post, I honestly didn’t know whether to laugh or to cry. Its caption caught my eye: “Joe Biden can save restaurants with the stroke of a pen. Here’s how.” Intrigued, I read. I’ll save you the trouble. Their proposal is that Joe Biden lift the tariff on European wines and foods. My offhand guess is that if I checked out the menus of the first 100 restaurants I encountered fewer than 10% offer European wines and foods. For every Chez Panisse there are dozens, maybe even hundreds of McDonalds, Burger Kings, and Pizza Huts to mention Yellow Roses:

and
East of Edenses:

I suspect their proposal would do little to “save restaurants” although it might actually help their own establishments.

All of that having been said, I agree with the material of their suggestion. Those tariffs should be lifted. They were imposed because of the competition that EU- and nationally-subsidized Airbus gives to Boeing. In my view most of Boeing’s problems are self-inflict, many of them a consequence of offshoring their software development. I don’t believe that we should be in the business of indemnifying companies against the adverse consequences of their own folly. I think that Boeing should be able to design and produce its aircraft anywhere it chooses to but I also think that offshoring production, whether of software or hardware should render Boeing ineligible to bid on government contracts and Boeing should factor that into their planning. Clearly, we need to protect Boeing from itself and they need incentives.

But this all touches on a larger issue. There’s something I don’t think we’ve come to terms with yet. The post-pandemic economy is going to be very different from the economy of 2019. Restaurants and hospitality will never recover, at least not in the forms they took in 2019. It will take decades for air travel, indeed, the whole travel sector to recover.

We should seize this opportunity to rebuild the economy in direction more benign to more Americans. I doubt we will but we should.

I want to draw your attention to this dissenting account, by William Voegeli at City Journal of the suburbanization that took place from 1950 through 1980 in the United States. The prevailing wisdom is that it was motivated by white racism, full stop. The account relies heavily on the evolution of South Shore where Michelle Obama grew up.

IMO the suburbanization under discussion was multi-factorial of which white racism was one factor among many including housing costs, jobs, crime, drugs, the riots of the 1960s, and other, larger social changes.

Here’s a telling passage. Now there’s actually “black flight” to compare it with:

Indeed, a further reason to doubt that white flight was simply, or even primarily, due to racial prejudice is that “black flight,” a more recent development, is following the same course. Examining a development “crushing South Shore and other once-stable neighborhoods on the city’s South and West Sides”—namely, the “exodus of middle-class African-American families seeking safe neighborhoods and job opportunities”—a 2017 Tribune article quoted Jennifer and Jason Parks, who once lived on the block where Michelle Robinson grew up. The Parks family’s enough-is-enough moment came in 2014, when a 20-year-old man was fatally shot on their street while walking his younger brother to school. “South Shore ranks sixth among the city’s 77 community areas for incidents where one or more people were killed over the past decade,” the Tribune reported.

The dangers that, 50 years ago, caused the Robinsons’ white neighbors to move away are now causing black families to abandon South Shore. “If I was holding on to Chicago and something happened to one of our babies,” Mrs. Parks said, “it would crush me.” Rotella records that the net decline in South Shore’s black population between 2000 and 2014 was 12,790. (Its total population in 2015 was 51,451.) As of 2017, the Parks family was preparing to move into a new house in northern Indiana. There was nothing anomalous about their decision. Last year, the Chicago Sun-Times reported that “[t]he city’s black population has fallen from a peak of 1.2 million in 1980 to fewer than 800,000 now and is predicted to drop to 665,000 by 2030.”

In 1950 South Shore’s population was 79,000, mostly white, largely Jewish. When that population left South Shore, they were largely replaced by blacks. As middle class blacks flee South Shore for the suburbs, who will replace them? My answer: no one. There will be mile after mile of empty buildings or open fields where modest single-family homes used to be.