Reducing the Very Overpriced Cost of Healthcare

As is known to many people, American healthcare is far more expensive than necessary.

One of most enduring, economically and socially damaging, downright frustrating facts about life in the United States is how expensive health care is here. Not only does U.S. health care cost far more than in other advanced economies, but compared with the nations that spend less, we have worse or equivalent health outcomes. In fact, U.S. life expectancy now lags behind that of all the advanced economies.

An MRI scan that cost $1,400 here went for $450 in Britain and $190 in Holland. Thirty tablets of a drug to reduce the risk of blood clots (Xarelto) cost $380 here, $70 in Britain, $80 in Switzerland and $60 in Holland. Hospital admission for angioplasty is $32,000 here, $15,000 in Australia, $12,000 in Britain, $7,000 in Switzerland, $6,000 in the Netherlands.

Add to those differences the latest outrage in health-care costs: surprise medical billing, when even well-insured patients can wake up from surgery finding that they owe thousands of dollars, because someone treating them while they were unconscious was out of their insurance network.

Princeton economists Anne Case and Angus Deaton (a Nobel winner) recently summarized the problem by labeling it an $8,000-a-year annual health-care tax paid by U.S. families. This is the difference in costs between what we pay for health care and what people in other countries pay. As Case put it: “We can brag we have the most expensive health care. We can also now brag that it delivers the worst health of any rich country.”

Why call this expense a tax? Well, for one, if you want health coverage, you can’t escape it. But even if you don’t — and good luck with that — you still can’t escape the tax, as both employer- and government-provided health care extract payments through lower paychecks and public financing.

Case and Deaton may be erring on the low side in their $8,000-per-family figure. The Organization for Economic Cooperation and Development puts per-person spending in the United States at $8,950 a year. That compares with $5,060 in Germany, $3,470 in Canada and just $3,140 in Britain. If we assume a family of three, we would get an annual health-care tax of $11,670 compared with Germany and more than $17,000 compared with the cost of health care in Britain.

How can such differences persist, especially in a service where consumption is so essential to well-being? If ice cream were that much more expensive here, we’d have a lot to squawk about, for sure. But it wouldn’t be a matter of life and death.

An obvious, and correct, answer as to why U.S. health care is so expensive is because we do so little, relative to other systems, to control costs. But it’s worse than that. We do a fair amount to make health care more expensive.

First, our system of private insurance costs far more than single-payer systems like Canada’s, and also more than countries with private but heavily regulated insurers like Germany. OECD data show that as a share of health spending, our administrative costs are three times that of Canada’s and twice that of Germany’s. Getting our administrative costs closer to those in other countries would require regulating private insurers and expanding public coverage, but it could save us at least 10 percent of our total health-care bill.

Next, we pay twice as much to our health-care providers and for prescription drugs as everyone else. The latter costs us more than $3,000 per family per year. We pay more than twice as much for medical equipment, costing us a bit less than $1,500 per family per year. Doctors and dentists cost us close to an extra $750 per family per year.

One reason for the outsize costs of these inputs to U.S. health care is that government policy protects our providers. When it comes to manufactured goods, like cars and clothes and almost everything on the shelves of Walmart, economists and policymakers push for “free trade” and more competition. But when it comes to health-care providers, these same authorities turn protectionist.

In areas like prescription drugs and medical equipment, this protection is explicit: Manufacturers are granted patent monopolies. The government will arrest anyone who sells protected items in competition with a patent holder.

In the case of doctors, we have maintained or increased barriers that make it difficult for qualified foreign physicians to practice in the United States. We also prevent other health-care professionals, such as physicians’ assistants and nurse practitioners, from doing many tasks for which they are entirely competent. There is a similar story with dentists and dental hygienists.

Other countries directly control drug prices. In France, the government determines whether a new drug is an improvement or a copycat, and, if the drug is deemed useful, the government negotiates drug prices with the manufacturers and caps their revenue. When sales exceed the cap, the manufacturer must rebate most of the difference back to the government.

Here in the United States, we give drug companies and medical equipment manufacturers’ patent monopolies and allow them to charge whatever they want. We don’t even let the government use its massive leverage to negotiate lower drug prices for Medicare beneficiaries. That’s what makes these goods expensive; they’re almost always relatively cheap to produce.

This is fixable. It would take regulating costs, reducing reimbursements to providers and increasing competition.

The pharmaceutical industry’s rationale for cost-exploding medical patents is that it helps incentivize research and innovation. Without them, it’s likely that pharmaceuticals and medical equipment companies would do less speculative research. But it would take a fraction of the savings from reducing such protectionism to replace patent-support research with publicly supported research (for which we already spend $40 billion a year).

In terms of boosting competition, allowing foreign doctors whose training meets our standards to more easily practice medicine here would bring U.S. physicians’ pay in line with international standards. Of course, our doctors pay much more for their education than doctors trained elsewhere, so part of this new structure would also require reducing the domestic cost of medical education and alleviating some of the educational debt burden that U.S.-trained doctors have acquired.

Increasing competition would also require using antitrust measures to push back on the pricing power engendered by the consolidation of both hospital groups and medical practices. An analysis by the New York Times of 25 metro areas found that hospital mergers “have essentially banished competition and raised prices for hospital admissions.”

Even if we succeed in raising competition and reducing protectionism, health care will still be too expensive for many low- and moderate-income families, many of whom have suffered stagnant incomes in recent decades. Like every other wealthy country, we will need to get on a path to universal coverage. But whatever form that takes, if we can significantly reduce our current health-care tax, the savings will easily be large enough to extend quality, affordable coverage to every American.

Joe Biden’s Weaknesses Against Trump

Joe Biden may win the popular vote against Trump, but Biden’s similarities to Hillary Clinton means that he would likely enough lose the 2020 electoral college.

Supporters of Joe Biden are unlikely to be persuaded by most of the common criticisms. They know he can be rambling and unintelligible. They know his record is unimpressive and that he doesn’t really have “policy proposals”. None of this matters, though, because to them he has the most important quality of all: he can beat Donald Trump. Nothing you can say about the former vice-president’s record, platform or mental state matters next to the argument that he is the best hope Democrats have of getting Trump out of office.

There’s just one problem: it’s a myth. It is a myth just as it was a myth that Hillary Clinton was a good candidate against Trump. Biden is not, in fact, the pragmatic choice. He would not beat Trump. He would lose. And we must say this over and over again. Forget his flubs. Forget his finger-nibbling. Biden would be crushed by Trump. If you want Trump out of office, don’t support Biden.

Last time round, Clinton supporters lived in a strange kind of denial. Anyone could see she had unique vulnerabilities Trump could exploit. She was a Wall Street candidate, and he was running to “drain the swamp”. She was under investigation by the FBI, and his pitch was that Washington was corrupt. She had supported the catastrophic Iraq war, and he portrayed himself as an outsider opponent of those wars. Trump could “run to her left” and make criticisms she would be unable to respond to, because they were accurate. Clinton’s attempts to attack Trump as an out-of-touch, reckless billionaire sex criminal would fail, because Trump would point out that she herself was out of touch, bought by billionaires and had an unrepentant alleged sex criminal as her husband and chief campaign surrogate.

Joe Biden will face many of the same problems. He has been in Washington since the age of 30, representing Delaware, the “capital of corporate America”. He is infamous for his connections to the credit card industry, and he has lied about his degree of support for the Iraq war. Even Matthew Yglesias of Vox calls Biden the “Hillary Clinton of 2020” for his corporate ties and war support. It is worth remembering what being the “Hillary Clinton” of anything means in an election against Trump.

Consider the Ukraine scandal, which is far worse for Biden electorally than usually acknowledged. Democrats have made this the centerpiece of their impeachment case against Trump, setting aside Trump’s most consequential crimes in order to focus on the charge that Trump tried to force the Ukrainian government to investigate Joe and Hunter Biden. For Democrats, the scandal is clear-cut: Trump was abusing the power of his office to “damage a political rival”. And they believe that the American people will agree, and will be disturbed by Trump’s unethical behavior. They insist there was “no evidence” that Joe Biden did anything wrong, and that Trump and his associates have been unfairly trying to smear Biden.

Democrats who think this way are walking into a buzzsaw. Let us recall: Hunter Biden was paid up to $50,000 a month by a Ukrainian oil company. Officially, the chief Ukrainian prosecutor had an open investigation into that company. Joe Biden bragged about pressuring Ukraine to fire that prosecutor, which they did. Hunter Biden says he told his father about his position in Ukraine, and Joe Biden did not ask him to step down. Joe Biden contradicts his son’s story, saying they never discussed Hunter Biden’s “work” in Ukraine. One of them is not telling the truth.

Defenders of the Bidens like to point out that the prosecutor was fired for reasons that had absolutely nothing to do with Hunter Biden. In fact, there was widespread pressure to fire the prosecutor because he wasn’t doing enough on corruption investigations, and there was a consensus among experts that this was the case. Biden’s actions had absolutely nothing to do with his son and it is ridiculous to suggest that they did.

All this is true. But the important question is: does it sound good? And the answer is: no. It sounds terrible.

One reason Democrats are bad at politics is that they concern themselves too much with facts and not enough with impressions. With Clinton’s “emails scandal”, they tried to show Clinton had not technically violated the law, but having Barack Obama’s FBI actively investigating Clinton for possible criminal wrongdoing looked terrible regardless of the facts.

Left-leaning journalists and pundits love to “fact-check” Trump, as if proving that he has lied is in itself persuasive. But 2016 should have showed us how powerless “debunking” is next to “optics”. If you have a Democratic candidate who looks really corrupt, it doesn’t matter if they’re not. People don’t trust the press and they don’t trust politicians.

Imagine Biden running against Trump. Trump will run ads like this, over and over. Good luck responding. Remember that time you have to spend defending yourself against Trump’s accusations is time not spent talking about issues that affect people’s lives. And Biden has already shown little interest in drawing people’s attention to the areas where Democrats should run strong against Trump, such as healthcare, taxation, working conditions and the climate crisis.

[…]

Ask yourself: how likely is such a candidate to win? Is such a person really the one you want to run against Trump? Look at the enthusiasm Trump gets at his rallies. It is real. Trump has fans, and they’re highly motivated. How motivated are Biden’s “fans”? Is Biden going to fill stadiums? Are people going to crisscross the country knocking on doors for him? Say what you want about Clinton, but there were some truly committed Clinton fans, and she had a powerful base of support. By comparison, Biden looks weak, and Trump is savagely effective at preying on and destroying establishment politicians.

Complicated factchecks that attempt to explain the nuances of the Ukrainian criminal prosecution system will not help Biden. People’s already limited enthusiasm for Biden will further wane, and Trump will point to his “strong economy” and “job creation” as evidence Obama and Biden were weak failures. Biden will look tired and irrelevant, and possibly forget why he is even running in the first place. Trump will be re-elected comfortably.

If there are Biden supporters in your life, you need to have serious conversations with them. Do not dwell on things that do not matter to them, like Biden’s record on bussing, or his latest nonsensical comment. Instead, keep the focus on the main argument that is sustaining his campaign: the idea that he is the best candidate to beat Trump. He isn’t. His electability is a myth, and when we look honestly at the facts we can see that Biden is actually a dangerously poor candidate to run.

The Dangerous Potential of War With Iran

Yesterday, U.S. bombing killed Iranian general Qasem Soleimani at Baghdad Airport in Iraq. This was an act of war ordered by the U.S. president against Iran (itself an impeachable offense since it was unconstitutionally executed without Congressional authorization). Now it’s a real possibility that the United States may soon become involved in a war with Iran. This is quite concerning for a number of reasons, one of which is that U.S. military intervention since the end of WWII has typically been disastrous for the invaded country. There’s the killing of civilians and bombing of civilian infrastructure (notably the dams) in North Korea, the Vietnam war that people there are still suffering from (estimates are that “at least 350,000 tons of live bombs and mines” remain there), and the criminal invasion of Iraq that resulted in a few hundred thousand deaths, just to name a few examples. So there’s this record of disaster for American military adventures, and there might soon be yet another one to add.

There’s also the U.S. backed overthrow of the democratically elected Iranian government in 1953, which lead to the dictatorial Shah ruling Iran until 1979. It was recently revealed through declassified documents that — surprise surprise — the reason for the U.S. doing this was for oil contracts that would benefit American oil corporations. But shouldn’t the American government be nicer to Iran based on what it did to it in the past?

It should be, but it hasn’t been. And the CIA backed overthrow may be the most significant U.S. event against Iran, but it isn’t even the only one. There are at least two more events.

One of them is when the U.S. supported Saddam Hussein’s government when it used a chemical weapons attack against Iran. As shown with the outrage over 2018’s chemical weapons attacks around Syria, it is a heinous type of attack and correctly condemned as an atrocity in war. How interesting it then is that the U.S. government knowingly supported a military that did this, and how interesting how seldom this is mentioned today.

The other event is when the U.S. shot down a civilian Iranian plane in July 1988, which killed the 290 civilians on board. The U.S. government maintained that it was an accident, and maybe it was, but it’s difficult to trust that’s the truth considering what else the U.S. was doing to Iran in the 1980s. In April 1988 for example, an engagement with Iran known as “Operation Praying Mantis” resulted in the death of two American pilots shot down with their helicopter.

In any case though, if Iran had shot down a civilian American plane with 290 civilians — including 66 children — it would clearly be an event remembered much more in America than the Iran Air Flight 655 incident is. That’s a useful thought experiment — to compare what the U.S. has done to damage other countries and try imagining a scenario where other countries did the same to the U.S.

Additionally, invading Iran isn’t like invading comparatively defenseless countries such as Afghanistan and Somalia. Iran is actually a developed country and it has a real defense system, one that’s been at $13 billion (about 2.67 percent of Iranian GDP) annually but could increase quickly. It may be defeated by the U.S. in a war, but it would put up a fight that would almost certainly lead to real direct damage to the U.S. Who wants to imagine the possibility of Iranian bombers flying over American cities?

In sum, a war with Iran is an incredibly reckless and stupid decision. If it happens, people will face significant unnecessary suffering and the world will clearly be worse off because of it.

Major Benefits of Reducing Air Pollution

Air pollution has for many years been a major public health problem that doesn’t receive much attention despite its significant effects on the population. It has been estimated that the majority of people in the world are regularly breathing unclean air.

Reductions in air pollution yielded fast and dramatic impacts on health-outcomes, as well as decreases in all-cause morbidity, according to findings in “Health Benefits of Air Pollution Reduction,” new research published in the American Thoracic Society’s journal, Annals of the American Thoracic Society.

The study by the Environmental Committee of the Forum of International Respiratory Societies (FIRS) reviewed interventions that have reduced air pollution at its source. It looked for outcomes and time to achieve those outcomes in several settings, finding that the improvements in health were striking. Starting at week one of a ban on smoking in Ireland, for example, there was a 13 percent drop in all-cause mortality, a 26 percent reduction in ischemic heart disease, a 32 percent reduction in stroke, and a 38 percent reduction in chronic obstructive pulmonary disease (COPD). Interestingly, the greatest benefits in that case occurred among non-smokers.

“We knew there were benefits from pollution control, but the magnitude and relatively short time duration to accomplish them were impressive,” said lead author of the report, Dean Schraufnagel, MD, ATSF. “Our findings indicate almost immediate and substantial effects on health outcomes followed reduced exposure to air pollution. It’s critical that governments adopt and enforce WHO guidelines for air pollution immediately.”

In the United States, a 13-month closure of a steel mill in Utah resulted in reducing hospitalizations for pneumonia, pleurisy, bronchitis and asthma by half. School absenteeism decreased by 40 percent, and daily mortality fell by 16 percent for every 100 ?g/m3 PM10 (a pollutant) decrease. Women who were pregnant during the mill closing were less likely to have premature births.

A 17-day “transportation strategy,” in Atlanta, Georgia during the 1996 Olympic Games involved closing parts of the city to help athletes make it to their events on time, but also greatly decreased air pollution. In the following four weeks, children’s visits for asthma to clinics dropped by more than 40 percent and trips to emergency departments by 11 percent. Hospitalizations for asthma decreased by 19 percent. Similarly, when China imposed factory and travel restrictions for the Beijing Olympics, lung function improved within two months, with fewer asthma-related physician visits and less cardiovascular mortality.

In addition to city-wide polices, reducing air pollution within the home also led to health benefits. In Nigeria, families who had clean cook stoves that reduced indoor air pollution during a nine-month pregnancy term saw higher birthweights, greater gestational age at delivery, and less perinatal mortality.

The report also examines the impact of environmental policies economically. It highlights that 25 years after enactment of the Clean Air Act, the U.S. EPA estimated that the health benefits exceeded the cost by 32:1, saving 2 trillion dollars, and has been heralded as one of the most effective public health policies of all time in the United States. Emissions of the major pollutants (particulate matter [PM], sulfur oxides, nitrogen oxides, carbon monoxide, volatile organic compounds, and lead) were reduced by 73 percent between 1990 and 2015 while the U.S. gross domestic product grew by more than 250 percent.

Given these findings, Dr. Schraufnagel has hope. “Air pollution is largely an avoidable health risk that affects everyone. Urban growth, expanding industrialization, global warming, and new knowledge of the harm of air pollution raise the degree of urgency for pollution control and stress the consequences of inaction,” he says. “Fortunately, reducing air pollution can result in prompt and substantial health gains. Sweeping policies affecting a whole country can reduce all-cause mortality within weeks. Local programs, such as reducing traffic, have also promptly improved many health measures.”

Abortion Reversal — The Dangerous Practice You’ve Probably Never Heard Of

In the United States, many more laws have been implemented that restrict or ban a woman’s ability to have an abortion. Abortion reversal is a new technique that hasn’t undergone much medical testing since the one test on it showed significant harm to the women.

Several states now require women who seek medication abortions to be provided with dubious information that the procedure could be stopped, allowing a pregnancy to continue.

But when researchers attempted to carry out a legitimate study of whether these “abortion reversal” treatments were effective and safe, they had to stop almost immediately – because some of the women who participated in the study experienced dangerous hemorrhaging that sent them to the hospital.

By passing these abortion reversal laws, “states are encouraging women to participate in an unmonitored experiment,” Creinin said.

Creinin and his colleagues detailed their concerns in a commentary in the journal Contraception, and they will publish their study in January’s edition of Obstetrics and Gynecology.

Medication abortions, which are used up to 10 weeks into a pregnancy, consist of taking two pills in sequence. The first pill in the regimen, mifepristone, loosens the pregnancy’s attachment to the uterus. The second pill, misoprostol, forces the uterus to contract to push out the pregnancy. The pills must be taken consecutively to complete the abortion, and there’s a chance the pregnancy will continue if the second pill is not taken.

A total of 862,320 abortions were provided in clinical settings in 2017, according to the Guttmacher Institute, about 39 percent of which were medication abortions. Research has shown that using these drugs is a safe way to end a pregnancy.

Some antiabortion activists and legislators claim that not taking the second pill, or giving a woman high doses of the hormone progesterone after taking mifepristone, can help stop, or “reverse,” a medical abortion.

The American College of Obstetricians and Gynecologists firmly states that “claims regarding abortion ‘reversal’ treatment are not based on science and do not meet clinical standards” and say the purported studies that underpin these antiabortion arguments lack scientific rigor and ethics.

Despite this, the claims made in these discredited studies have worked their way to antiabortion lawmakers, who in turn have put them into abortion reversal legislation that was signed by governors in North Dakota, Idaho, Utah, South Dakota, Kentucky, NebraskaOklahoma and Arkansas. The laws are currently blocked or enjoined in Oklahoma and North Dakota.

Because reliable research on these treatments is nonexistent, earlier this year, Creinin and his colleagues designed a legitimate double-blind, placebo-controlled, randomized trial that aimed to observe 40 volunteers who had already elected to have a surgical abortion.

Their goal was to see if giving progesterone to women who took the first pill in the prescribed regimen would effectively and safely halt an abortion.

After the women took the first pill in the abortion protocol, mifepristone, rather than take the second pill, misoprostol, they were either given a placebo or a dose of progesterone.

Researchers only enrolled 12 women before they had to stop the study.

Bleeding is normal during a medication abortion. But three of the women who enrolled in the UC-Davis study experienced far more serious bleeding than anyone could have anticipated when the second pill was not administered.

One woman “was so scared she called an ambulance,” while another woman startled by the amount of blood “called 911 and crawled into her bathtub”, Creinin said. A third woman who went to the emergency room needed a transfusion. One of the women had received a placebo, while two others had taken the progesterone.

Creinin and his colleagues halted the study as soon as it became clear that they could not proceed safely.

“I feel really horrible that I couldn’t finish the study. I feel really horrible that the women … had to go through all this,” Creinin said. Because the study ended prematurely, the researchers could not establish any evidence that progesterone was an effective way to stop a medication abortion.

“What the results do show, though, is that there’s a very significant safety signal” when it comes to disrupting the approved medication abortion protocol, Creinin said.

In their upcoming paper in Obstetrics and Gynecology, the researchers warn that “patients in early pregnancy who use only mifepristone may be at high risk of significant hemorrhage.”

Medical experts are so concerned about abortion reversal laws that the American Medical Association joined a lawsuit against North Dakota’s abortion reversal law, which was blocked by a federal judge in September.

The North Dakota abortion reversal law, signed by Gov. Doug Burgum (R) in March, instructed health-care providers to tell a woman “that it may be possible to reverse the effects of an abortion-inducing drug if she changes her mind, but time is of the essence” and to provide a woman with literature on how to do this. The law fails to specify what that literature would include, or what such a treatment might entail.

Orwell’s 1984 — Too Real in the 2010s

The interpretation of Orwell’s 1984 that I have is that the mere possibility that people may be being watched by a powerful, corrupt state changes behavior in a way that has significant implications across society. It’s been found in research that people change their behavior when they know they are being watched.

There’s no poking holes in the Party’s control, no loose thread for any opposition to pull. If there is a Resistance, it vanishes halfway through. The book is designed to make The Party and its machinery of oppression look entirely infallible. You accept, like the protagonist Winston Smith, that it can never be overthrown. This isn’t The Hunger Games. There is no cartoonish YA villain like President Snow for a defiant Katniss Everdeen to topple. Even Margaret Atwood, in The Handmaid’s Tale, destroyed Gilead in a far-future postscript.

But 1984? So far as we know, it’s boots on human faces all the way down.

How come? The Party doesn’t get its power from spying on its citizens, or turning them into snitches, or punishing sex crimes. All were presented as mere tools of the state. How did it come to wield that control in the first place?

Orwell, aka Eric Blair, a socialist freedom fighter and a repentant former colonial officer who had a lifelong fascination with language and politics, knew that no control could be total until you colonized people’s heads too. A state like his could only exist with loud, constant, and obvious lies.

To be a totalitarian, he knew from his contemporary totalitarians, you had to seize control of truth itself. You had to redefine truth as “whatever we say it is.” You had to falsify memories and photos and rewrite documents. Your people could be aware that all this was going on, so long as they kept that awareness to themselves and carried on (which is what doublethink is all about).

The upshot is, Winston Smith is gaslit to hell and back. He spends the entire novel wondering exactly what the truth is. Is it even 1984? He isn’t sure. Does Big Brother actually physically exist somewhere in Oceania, or is he just a symbol? ¯\_(ツ)_/¯

Winston is what passes for well-educated in his world; he still remembers the name “Shakespeare.” He’s smart enough not to believe the obvious propaganda accepted by the vast majority, but it doesn’t matter. The novel is about him being worn down, metaphorically and physically, until he’s just too tired and jaded to hold back the tide of screaming nonsense.

Don’t call him Winston Smith. Call him Mr. 2019. Because it’s looking increasingly like we live in Oceania. That fictional state was basically the British Isles, North America, and South America. Now the leaders of the largest countries in each of those regions — Boris Johnson, Donald Trump, Jair Bolsonaro — are men who have learned to flood the zone with obvious lies, because their opponents simply don’t have the time or energy to deal them all.

As we enter 2020, all three of them look increasingly, sickeningly, like they’re going to get away with it. They are protected by Party members who will endure any humiliation to trumpet loyalty to the Great Leader (big shout-out once again to Sen. Lindsay Graham) and by a media environment that actively enables political lies (thanks, Facebook).

All the Winston Smiths of our world can see what the score really is. It doesn’t seem to make any difference. But hey, at least we’re all finally aware of the most important line in 1984, which is now also its most quote-tweeted: “The party told you to reject the evidence of your eyes and ears. It was their final, most essential command.”

In the decades following its 1949 publication, the message of 1984 became corrupted. Popular culture reduced it to a single slogan — Big Brother is Watching You — and those with only a vague memory of studying the book in school thought the surveillance state was the main thing Orwell was warning against.

That was certainly where we were at in 2013, when Edward Snowden released his treasure trove of documents that proved the vast scale of NSA spying programs. “George Orwell warned us of the danger of this kind of information,” Snowden told UK TV viewers in his “alternate Christmas message” that year. “The types of collection in [1984] — microphones and video cameras, TVs that watch us — are nothing compared to what we have available today.”

Which was true, but also beside the point. Orwell doesn’t actually claim the surveillance system in Oceania is all that strong. It would have strained credulity to have a Party that watched all of its members all of the time. It sounded like a bad science fiction plot. (In China, where the growing state systems of facial recognition and social media post ranking make NSA programs look like amateur hour, it no longer does).

In 1984, the only time we definitively know a telescreen is watching Winston is when he’s doing morning exercise and a female instructor calls him out for not pushing hard enough. Here in the real future, people pay Peloton $2200 plus $40 a month for the same basic setup.

It isn’t that Big Brother is watching — that too is another Party lie. It’s that he may be watching, just as knowing there may be a speed camera around the next bend keeps your mph in line. Against that possibility, citizens can still rebel. For much of the book, Winston and Julia are able to escape all cameras, out in the post-atomic countryside. Avoiding surveillance doesn’t matter. What causes their capture is the fact that they fell for a lie (the “Brotherhood,” a fake Resistance operation run by the Inner Party member O’Brien).

We are invited to consider whether we too are falling for The Party’s lies. The book-within-a-book that explains the shape of Winston’s world turns out to be written by O’Brien, the master liar. The rocket bombs dropping on London are dropped by the Party. All the in-universe truth the reader has to go on is Winston’s word, and by the end — as he is tortured into genuinely seeing O’Brien hold up three fingers instead of two, then thinks he hears news of a final victory in the endless war — even that isn’t reliable.

By the end of this decade, even words like “Orwell” and “Orwellian” had become ambivalent. I realized this in 2017 when my wife, knowing my love of the book, had bought me a cap that said “Make Orwell Fiction Again.” I loved it until I found it had been made in a state that voted for Trump, by a company with a line of libertarian merch. We saw the cap as a riposte to the MAGA mentality, but it was also possible to see it as a reinforcement: Make Orwell fiction again by helping Trump fight Deep State surveillance, man!

If there is hope for Oceania in the coming decade, it may come from uniting people under the banner of all that 1984 warns against — starting with the bare-faced lies that Orwell was most concerned about. The lies that social media gatekeepers have taken way too long to notice, if they notice them at all.

If we can’t agree on basic facts of science and history, we’re lost. But if we the people can do that, there’s no surveillance system or endless war or sexcrime we can’t dismantle. “Freedom is the freedom to say that two plus two makes four,” Winston wrote in his diary. “If that is granted, all else follows.”

By remaining skeptical about all we read, but still reading widely and clawing our way back to a world of truths that are as simple and as objective as math, we can prove that we finally learned Orwell’s lesson. And we can make 1984 merely a masterpiece of fictional worldbuilding again.

Unjust Voter Purges in Georgia and Wisconsin Will Likely Contribute to the Tipping of the 2020 Election

America masquerades as a democracy. As shown with articles such as the one below, at best, it is a country with some functioning but flawed democratic structures. The idea that rescinding someone’s eligibility to vote based on them not voting in some past elections is an absurd assault on voting rights, but that’s what’s being done by the Republican party in these instances in the swing states of Georgia and Wisconsin.

Republicans are intensifying efforts to aggressively purge the voter rolls in Wisconsin and Georgia before the 2020 elections, potentially giving their party a crucial advantage by shrinking the electorate in two key swing states.

On Friday, a state judge in Wisconsin ruled that the state could begin canceling the registrations of 234,000 voters—7 percent of the electorate—who did not respond to a mailing from election officials. The Wisconsin Elections Commission, a bipartisan group overseeing state elections, had planned to wait until 2021 to remove voters it believes have moved to a new address. But in response to a lawsuit from a conservative group, the Wisconsin Institute for Law & Liberty, Judge Paul Malloy, a Republican appointee, said those voters could be purged 30 days after failing to respond to a mailing seeking to confirm their address.

Republicans are intensifying efforts to aggressively purge the voter rolls in Wisconsin and Georgia before the 2020 elections, potentially giving their party a crucial advantage by shrinking the electorate in two key swing states.

On Friday, a state judge in Wisconsin ruled that the state could begin canceling the registrations of 234,000 voters—7 percent of the electorate—who did not respond to a mailing from election officials. The Wisconsin Elections Commission, a bipartisan group overseeing state elections, had planned to wait until 2021 to remove voters it believes have moved to a new address. But in response to a lawsuit from a conservative group, the Wisconsin Institute for Law & Liberty, Judge Paul Malloy, a Republican appointee, said those voters could be purged 30 days after failing to respond to a mailing seeking to confirm their address.

On Monday night, Georgia Secretary of State Brad Raffensperger removed 309,000 voters from the rolls—4 percent of the electorate—whose registrations were labeled inactive, including more than a hundred thousand who were purged because they had not voted in a certain number of previous elections.

These numbers are large enough to swing close elections. Donald Trump carried Wisconsin by 22,000 votes; the number of soon-to-be purged voters is more than 10 times his margin of victory. Democrat Stacey Abrams failed to qualify for a runoff against Brian Kemp in the 2018 governor’s race by 21,000 votes; the number of purged voters in Georgia is 14 times that.

These purges appear to disproportionately affect Democratic-leaning constituencies, including voters of color, students, and low-income people who tend to move more often. In Wisconsin, 55 percent of those on the purge list come from municipalities where Hillary Clinton defeated Trump in 2016. Nine of the 10 areas with the highest concentration of voters slated to be purged voted for Clinton. Milwaukee and Madison, the state’s two most Democratic areas, account for 14 percent of the state’s registered voters but 23 percent of those on the purge list, according to the Milwaukee Journal Sentinel.

For the past decade, Republican election officials and conservative groups have sought to expand the use of voter purges. They were aided in 2018 by a Supreme Court decision allowing states to remove people who had not voted in two or three previous elections, a move voting rights group said turned the right to vote into a “use it or lose it” privilege.

Both Wisconsin and Georgia have a recent history of inaccurate voter purges based on faulty data. In 2017, Wisconsin sought to remove 340,000 voters who the state government said had filed a change of address with the post office or registered their cars at an address other than the voter registration address. But at least 7 percent of the people on the list had not moved and should not have been on the purge list, according to the League of Women Voters of Wisconsin. Milwaukee removed 44,000 voters but later reinstated nearly half of them, who remained eligible to vote. The state’s new purge list “likely once again contains a substantial amount of unreliable and demonstrably inaccurate information,” according to a legal brief filed by the Wisconsin League of Women Voters. (Because Wisconsin has Election Day registration, purged voters can re-register at the polls, but they need to bring proof of address and a valid ID.)

“If our experience is anything like it was back in 2017-2018, where we lost thousands of voters, we’re afraid that history will repeat itself,” says Neil Albrecht, the executive director of Milwaukee’s Election Commission. “This will lead to people distrusting election administration in Wisconsin. If people feel like a system is rigged, it has a pretty profound impact on whether or not they feel it’s even worthwhile to participate in an election.”

Georgia purged 1.4 million people from 2012 to 2018. That included a purge of more than half a million people in the summer of 2017, the largest in state history. Seventy thousand people purged for having not voted in previous elections re-registered to vote in the 2018 election, and 65 percent of them re-registered in the same county, according to American Public Media, suggesting that they should not have been purged in the first place. Voters living in areas that went for Abrams over Kemp were more likely to be purged.

Earlier this year, the state of Ohio released a list of 235,000 voters slated to be purged. It turned out that 40,000 people shouldn’t have been on it. That included the head of the Ohio League of Women Voters, who had voted in three elections in the past year but nonetheless found herself labeled an inactive voter.

The same sort of problems appear to be resurfacing in the latest round of purging in Wisconsin and Georgia, with eligible voters wrongly targeted for removal.