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      in Elections

      The Biden Opportunity and How to Blow It

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      AdvertisementContinue reading the main storyOpinionSupported byContinue reading the main storyThe Biden Opportunity and How to Blow ItThe president-elect won promising conciliation. His choice of Xavier Becerra to run Health and Human Services promises culture war.By More

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      in Elections

      A Return to Decency

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      AdvertisementContinue reading the main storyOpinionSupported byContinue reading the main storyTurning PointsA Return to DecencyAs the ugly Trump era recedes, the United States should seek not a restoration but a reinvention of old ties.By More

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      in Elections

      How Dinkins and Giuliani Foretold the Future of American Politics

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      I remember being at the hotel on election night in 1993 where Mayor David Dinkins and his supporters had gathered to celebrate what they hoped would be his re-election. I was a reporter for The Village Voice, and the polls had been close.But it was not to be. At a certain point in the evening, the local cable news network NY1 (just about a year old at the time) called the race for Rudy Giuliani. Shortly after, some members of the mayor’s entourage thundered past me.In the mayhem, I managed to make eye contact with Lee Jones, the mayor’s press secretary, whom I had known since he worked for Mayor Ed Koch (Mr. Dinkins kept him on). I could see he was distraught. “Well,” he said, “by and large, the coalition held. The coalition held.”That may sound like spin, but it wasn’t. We knew each other quite well. I took it that he was just trying to think of something hopeful to say — and in retrospect, he wasn’t wrong.As I’ve thought back on those years in the wake of Mr. Dinkins’s passing last week, I’m floored at the extent to which the politics of New York City foreshadowed the national politics of today. If the American polity consists of two warring camps right now, we might say that the New York of that time helped blaze that unhappy trail.The 1993 race was a rematch of their 1989 contest, when Mr. Dinkins beat Mr. Giuliani by less than 50,000 votes out of nearly two million cast. In the rematch, Mr. Giuliani won by about 53,000.Both men’s coalitions were remarkably sturdy. Even with a series of tumultuous situations — like the AIDS, heroin and crack cocaine epidemics, and dark economic times that forced Mr. Dinkins to enact severe budget cuts — two relatively marginal factors seemed to tip the election. First, Mr. Dinkins lost a few thousand mostly white voters over his too-tentative handling of a riot in the Brooklyn neighborhood Crown Heights and the boycott of two Korean-owned grocery stores by Black residents. Second, Mr. Giuliani benefited from a Staten Island secession referendum that Republicans had led the way to getting on the ballot. It goosed turnout in that borough, which benefited Mr. Giuliani (Republicans knew how to put a finger on the electoral scale even then).Mr. Dinkins’s coalition was liberal, multiracial and multiethnic. It arose and came together over the course of the 1970s and 1980s. For decades before him, New York City politics had been dominated by “the three I’s”: Italy, Ireland and Israel. For three citywide offices — mayor, comptroller and City Council president — it was often the case that one would go to an Italian, one to an Irishman (or by the 1970s, Irishwoman) and one to a Jew.In that arrangement, Black people and Latinos were junior partners, and they could not win the mayoralty because they could never coalesce around a single candidate. Meanwhile, the 1980s were happening: raging inequality and the AIDS crisis; a wave of crime and homelessness; the decade of the rise of the hedge-fund titans and Manhattan real estate celebrities (including you-know-who). In addition, Mr. Koch played increasingly to white racial backlash as the years went on. The Dinkins coalition — Black people, Latinos, gays, liberal Jews, immigrants, assorted others — was an emerging New York that was mostly not invited to the conspicuous prosperity of the ’80s enjoyed by Wall Street financiers and real estate developers. Mr. Dinkins’s most historically significant accomplishment was arguably not anything he did as mayor; it was to have assembled this coalition and, with his widely admired strategist Bill Lynch, proved to the world that it could win.The Giuliani coalition was the traditional and aging New York of wealthy Manhattan elites and white ethnic populations in other boroughs — the police and firefighters, the owners of the hardware and liquor stores in Howard Beach and Bensonhurst (the “red” parts of New York City), the pressmen at the Daily News plant, the sons and daughters of the men and women who had worked at the Brooklyn Navy Yard during the war.They were white. As such, they were privileged, even if it often didn’t feel that way to them. By and large they did not like the changes, like letting Black and Latino people into their unions and neighborhoods, that the emerging New York was seeking to impose on them. In Mr. Giuliani, they found their avenger.Fundamentally, those two coalitions in our largest city are now our two coalitions in the United States. And just as those two mayoral elections were close, hard-fought referendums on which New York would have power, our recent national elections have followed exactly the same pattern. Emerging America won in 2008 and 2012. Backlash prevailed narrowly in 2016. Then, a few thousand votes switched, and multiracial America won again.In some ways, I feel like I’ve been watching the same movie for 30 years. It even has some of the same stars, saying some of the same kinds of things. Of that 1989 election, Mr. Giuliani once told the journalist Jack Newfield: “They stole that election from me. They stole votes in the Black parts of Brooklyn, and in Washington Heights.”Mr. Dinkins, though a good and decent man, in the end didn’t have the political vision and will to transcend the divisions. Mr. Giuliani, like his friend President Trump, didn’t have them, either (in his case, more by choice).But these days I wonder who can transcend them. I know Joe Biden wants to, but I sure don’t get the feeling the other side wants to play along. Lee Jones was righter than he knew, not just about 1993 but also about what’s unfolded ever since: The two coalitions have not only held; they’ve metastasized. I may be watching this movie the rest of my life.The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips. And here’s our email: letters@nytimes.com.Follow The New York Times Opinion section on Facebook, Twitter (@NYTopinion) and Instagram. More

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      After 4 Years of Trump, Medicare and Medicaid Badly Need Attention

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      President-elect Joe Biden has pledged to “marshal the forces of science” in his administration. Undoubtedly he needs to start by bolstering the credibility of the Food and Drug Administration and the Centers for Disease Control and Prevention.But a third health agency, central to the lives of older Americans, low-income families and the disabled, is sorely in need of his attention. Science has also been under assault at the Centers for Medicare & Medicaid Services, which provides federal health insurance to more than 130 million Americans at a cost of more than $1 trillion, nearly twice the Pentagon’s budget.C.M.S. does more than just write checks for medical care. Its scientists and analysts determine which treatments should be offered — I am the chairman of the committee that advises Medicare on those decisions — and how best to care for the patients it serves.Unfortunately, the Trump White House has steadily eviscerated the agency’s dispassionate approaches to making those determinations.Recently, for instance, the Trump administration set in motion a plan to strip C.M.S. of its ability to assess for itself whether new medical devices approved by the F.D.A. are appropriate for the older patients it covers. This is important because the benefits and risks of such devices and procedures, which range from implantable hips and cardiac stents to digital apps and laboratory tests, can vary widely based on patient age and disability.The proposed rule requires Medicare to pay for any new device so long as the F.D.A. labels it a “breakthrough.” And that word does not mean what you think it does.The F.D.A. calls a device a “breakthrough” when it is expected — though not yet proved — to be helpful to patients with serious conditions. The designation has nothing to do with how the device works in older patients, or even if it was studied in that population at all. The proposed rule would also require Medicare to cover any new drug or device if at least one commercial insurer covers it for its members, even if its members are young and healthy.Already, companies seldom generate enough data on their products for C.M.S. to assess their value for its patients. In 2019, for instance, data was insufficient in just under half of new F.D.A. drug approvals to assess benefits or side effects in older patients. The proposed rule would drain the last remaining motivation that companies have to study their treatments in the patients who are likely to ultimately receive them.C.M.S. scientists and analysts do more than evaluate new treatments. They also test alternative ways to organize and pay for patient care. The agency has found, for example, that enrolling people at risk of diabetes in gym sessions reduced how often they were hospitalized. But some seemingly obvious ways to improve health care don’t work: C.M.S. also found it could not reduce hospitalizations for cancer patients by paying their doctors to actively manage their patients’ care.The fact that so many promising ideas don’t work as expected is the reason C.M.S. needs to double down on evaluations of how medical care is delivered to its patients.This administration has gone in the other direction. Just before the election, the White House conjured up a plan to send older people a $200 prescription drug discount card in the mail. Research has already demonstrated that if you give people money to buy prescription drugs, they will buy more of them. The pharmaceutical industry knows this, too. That’s why it hands out coupons worth billions of dollars.These same studies also show that when people are indiscriminately given cash for medicines — instead of only those who need that money the most — it costs much more overall than it saves. No wonder the discount card giveaway would have cost around $8 billion. Fortunately, the president has yet to follow through with it.In another troubling development, the administration announced on Nov. 20 that it would run an experiment in which reimbursements to physicians will be cut for dozens of high-cost drugs they administer in the office, such as chemotherapies and treatments for inflammatory diseases.C.M.S. financial analysts warned that the cuts will lead many Medicare patients to lose access to these important treatments. Scientists should evaluate this prediction by including a comparison group of patients whose doctors would not receive a cut in payment. But the agency administrator made it clear that she didn’t believe the warning. No comparison group is planned. That is no way to evaluate whether our nation’s vulnerable would be helped or hurt by this significant policy change.Another example of a poorly designed experiment involved taking Medicaid coverage away from able-bodied people who are not working or going to school, under an ill-founded theory that doing so would inspire them to seek employment. Such a study is best done narrowly, so that any harms are minimized. Instead, the administration invited multiple states in 2018 to test the outcome.A Harvard study found that a work requirement in Arkansas led to a rise in the number of uninsured people and no significant changes in employment. Thousands of Medicaid beneficiaries in Michigan and New Hampshire were set to lose their coverage before work requirements in those states were ended. Given those results, the overall program should have been canceled. The administration broadened it.Through its reliance on scientific evaluation of what it should pay for, and how, C.M.S. has remained financially viable for more than half a century. As the new president plans to fix the damage done by the current president, this vital agency demands his attention.Peter B. Bach is a physician at Memorial Sloan Kettering Cancer Center. He served as a senior adviser to the administrator of the Centers for Medicare and Medicaid Services in 2005 and 2006.The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips. And here’s our email: letters@nytimes.com.Follow The New York Times Opinion section on Facebook, Twitter (@NYTopinion) and Instagram. More

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      in Elections

      Happy Thanksgiving to All Those Who Told the Truth in This Election

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      With so many families gathering, in person or virtually, for this most unusual Thanksgiving after this most unusual election, if you’re looking for a special way to say grace this year, I recommend the West Point Cadet Prayer. It calls upon each of these future military leaders to always choose “the harder right instead of the easier wrong” and to know “no fear when truth and right are in jeopardy.”Because we should be truly thankful this Thanksgiving that — after Donald Trump spent the last three weeks refusing to acknowledge that he’d lost re-election and enlisted much of his party in a naked power play to ignore the vote counts and reinstall him in office — we had a critical mass of civil servants, elected officials and judges who did their jobs, always opting for the “harder right” that justice demanded, not the “easier wrong” that Trump and his allies were pressing for.It was their collective integrity, their willingness to stand with “Team America,” not either party, that protected our democracy when it was facing one of its greatest threats — from within. History will remember them fondly.Who am I talking about? I am talking about F.B.I. Director Christopher Wray, a Trump appointee, who in September openly contradicted the president and declared that historically we have not seen “any kind of coordinated national voter fraud effort in a major election” involving mail-in voting.I am talking about Georgia Secretary of State Brad Raffensperger — a conservative Republican — who oversaw the Georgia count and recount and insisted that Joe Biden had won fair and square and that his state’s two G.O.P. senators, David Perdue and Kelly Loeffler, did not garner enough votes to avoid election runoffs. Perdue and Loeffler dishonorably opted for the easier wrong and brazenly demanded Raffensperger resign for not declaring them winners.I am talking about Chris Krebs, the director of the Cybersecurity and Infrastructure Security Agency, who not only refused to back up Trump’s claims of election fraud, but whose agency issued a statement calling the 2020 election “the most secure in American history,” adding in bold type, “There is no evidence that any voting system deleted or lost votes, changed votes or was in any way compromised.”Krebs did the hard right thing, and Trump fired him by tweet for it. Mitch McConnell, doing the easy wrong thing, did not utter a peep of protest.I am talking about the Republican-led Board of Supervisors in Maricopa County, Ariz., which, according to The Washington Post, “voted unanimously Friday to certify the county’s election results, with the board chairman declaring there was no evidence of fraud or misconduct ‘and that is with a big zero.’”I am talking about Mitt Romney, the first (and still virtually only) Republican senator to truly call out Trump’s postelection actions for what they really were: “overt pressure on state and local officials to subvert the will of the people and overturn the election.”I am talking about U.S. District Judge Matthew W. Brann, a registered Republican, who dismissed Trump’s allegations that Republican voters in Pennsylvania had been illegally disadvantaged because some counties permitted voters to cure administrative errors on their mail ballots.As The Washington Post reported, Brann scathingly wrote on Saturday “that Trump’s attorneys had haphazardly stitched this allegation together ‘like Frankenstein’s Monster’ in an attempt to avoid unfavorable legal precedent.”And I am talking about all the other election verification commissioners who did the hard right things in tossing out Trump’s fraudulent claims of fraud.Asking for recounts in close elections was perfectly legitimate. But when that failed to produce any significant change in the results, Trump took us to a new dark depth. He pushed utterly bogus claims of voting irregularities and then tried to get Republican state legislatures to simply ignore the popular vote totals and appoint their own pro-Trump electors before the Electoral College meets on Dec. 14.That shifted this postelection struggle from Trump versus Biden — and who had the most votes — to Trump versus the Constitution — and who had the raw power and will to defend it or ignore it.To all of these people who chose to do the hard right thing and defend the Constitution and the rule of law over their party’s interest or personal gain, may you have a blessed Thanksgiving.You stand in stark contrast to Bill Barr, Mike Pompeo (who apparently never attended chapel at West Point), Mike Pence, Rudy Giuliani, Lindsey Graham, Mitch McConnell, Kevin McCarthy, Nikki Haley, Kayleigh McEnany and all the other G.O.P. senators and House members, who put their party and self-interest before their country and opted for the easy wrongs. History will remember them, too.Though Trump is now grudgingly letting the presidential transition proceed, we must never, ever, forget the damage he and his allies inflicted on American democracy by attacking its very core — our ability to hold free and fair elections and transfer power peacefully. Tens of millions of Americans now believe something that is untrue — that our system is rigged. Who knows what that will mean in the long run?The depths to which Trump and his legal team sank was manifested last Thursday when Giuliani and Sidney Powell held a news conference alleging, among other things, that software used to disadvantage Trump voters was created at the direction of the late Venezuelan President Hugo Chávez. It was insane.As Jonah Goldberg, a conservative critic of Trumpism, wrote in thedispatch.com: “The G.O.P.’s social media account spewed sound bites from Powell and Giuliani out into the country like a fire hose attached to a sewage tank.” Fox carried the whole news conference live — uninterrupted — for virtually its entire 90 minutes.Shame on all these people.Sure, now Trump and many of his enablers are finally bowing to reality — but it is not because they’ve developed integrity. It is because they WERE STOPPED by all those people who had integrity and did the hard right things.And “shame” is the right word for these people, because a sense of shame was lost these past four years and it needs to be re-established. Otherwise, what Trump and all his sycophants did gets normalized and permanently erodes confidence in our elections. That is how democracies die.You can only hope that once they are out of power, Barr, Pompeo, Giuliani and all their compatriots will be stopped on the streets, in restaurants or at conferences and politely but firmly asked by everyday Americans: “How could you have stayed all-in when Trump was violating the deepest norms that bind us as a democracy?”And if they are deaf to the message being sent from their fellow citizens, then let’s hope some will have to face an interrogation from their own children at the Thanksgiving table this year:“Mom, Dad — did you really side with Trump when it was Trump versus the Constitution?”The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips. And here’s our email: letters@nytimes.com.Follow The New York Times Opinion section on Facebook, Twitter (@NYTopinion) and Instagram. More

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      in World Politics

      What Really Makes America Great

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      This year’s US presidential election is likely to unleash the most polarizing discourse we’ve seen in decades. We’re likely to hear both sides use extreme labels like fascist, socialist and racist. We’ve already seen a clear schism between the parties and an equally deep-seated hostility within the parties. A Better Way to Connect in Lockdown […] More